Provider Demographics
NPI:1033603493
Name:JOBE, MICHELLE RENEE (LVN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RENEE
Last Name:JOBE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:RENEE
Other - Last Name:SALAICES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:2201 TUOLUMNE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2524
Mailing Address - Country:US
Mailing Address - Phone:707-553-8199
Mailing Address - Fax:
Practice Address - Street 1:2201 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2524
Practice Address - Country:US
Practice Address - Phone:707-553-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN240090164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse