Provider Demographics
NPI:1154502342
Name:TODESCO, MICHELLE (RN, FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:
Last Name:TODESCO
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25941 TREE TOP RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 W LINCOLN AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-2936
Practice Address - Country:US
Practice Address - Phone:714-922-4196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2011-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19021363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health