Provider Demographics
NPI:1417413337
Name:NEMEH, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NEMEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31938 TEMECULA PKWY STE A337
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6810
Mailing Address - Country:US
Mailing Address - Phone:866-270-0062
Mailing Address - Fax:
Practice Address - Street 1:5310 W THUNDERBIRD RD STE 203
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4712
Practice Address - Country:US
Practice Address - Phone:480-292-8488
Practice Address - Fax:480-292-8292
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant