Provider Demographics
NPI:1265038830
Name:MILLAN-PATTERSON, MICHELE V (AGNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:V
Last Name:MILLAN-PATTERSON
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3089 RYAN AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-7764
Mailing Address - Country:US
Mailing Address - Phone:559-473-5442
Mailing Address - Fax:
Practice Address - Street 1:601 HAWAII ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4814
Practice Address - Country:US
Practice Address - Phone:559-473-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95015935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner