Provider Demographics
NPI:1376966473
Name:LAM, MICHELLE CHRISTINE (RN)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:LAM
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 1:21815 EVENINGSIDE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2406
Mailing Address - Country:US
Mailing Address - Phone:949-295-6963
Mailing Address - Fax:
Practice Address - Street 1:28201 MARGUERITE PKWY
Practice Address - Street 2:SUITE 13
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3719
Practice Address - Country:US
Practice Address - Phone:949-364-3928
Practice Address - Fax:949-364-2297
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA846329163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse