Provider Demographics
NPI:1235782624
Name:BARRETT, MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BARRETT
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 1:2279 45TH ST BLDG 1
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1514
Mailing Address - Country:US
Mailing Address - Phone:916-703-2616
Mailing Address - Fax:916-734-5959
Practice Address - Street 1:2279 45TH ST BLDG 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1514
Practice Address - Country:US
Practice Address - Phone:916-703-2616
Practice Address - Fax:916-734-0980
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95095600163WP0218X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0218XNursing Service ProvidersRegistered NursePediatric OncologyGroup - Single Specialty