Provider Demographics
NPI:1437513702
Name:WHITE, MICHELLE LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5558 CAPELLA PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-2279
Mailing Address - Country:US
Mailing Address - Phone:909-201-6169
Mailing Address - Fax:909-561-1514
Practice Address - Street 1:5558 CAPELLA PL
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-2279
Practice Address - Country:US
Practice Address - Phone:909-201-6169
Practice Address - Fax:909-561-1514
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA737749163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse