Provider Demographics
NPI:1164990727
Name:REDELL, MICHELLE JEANINE (LVN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JEANINE
Last Name:REDELL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:JEANINE
Other - Last Name:MACKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:590 B ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-5004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:590 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-5004
Practice Address - Country:US
Practice Address - Phone:510-820-3047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267698164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse