Provider Demographics
NPI:1174541171
Name:PRATT, MICHELLE DENISE (NPF)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DENISE
Last Name:PRATT
Suffix:
Gender:F
Credentials:NPF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21299
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-4299
Mailing Address - Country:US
Mailing Address - Phone:562-989-2374
Mailing Address - Fax:562-989-2364
Practice Address - Street 1:2840 LONG BEACH BLVD
Practice Address - Street 2:STE 365
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1516
Practice Address - Country:US
Practice Address - Phone:562-989-2374
Practice Address - Fax:562-989-2364
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402222363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA402222OtherBOARD OF NURSING LICENSE
CA402222OtherBOARD OF NURSING LICENSE