Provider Demographics
NPI:1104036151
Name:MISENER, MICHELE C (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:C
Last Name:MISENER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 VOLEYN ST
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2860
Mailing Address - Country:US
Mailing Address - Phone:916-830-1521
Mailing Address - Fax:
Practice Address - Street 1:3230 PEACEKEEPER WAY
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-2600
Practice Address - Country:US
Practice Address - Phone:916-830-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management