Provider Demographics
NPI:1518381466
Name:WESTENDORF, MICHELE BLAKE (ANP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:BLAKE
Last Name:WESTENDORF
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:WESTENDORF
Other - Last Name:DOWDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1441 AVOCADO AVE
Mailing Address - Street 2:STE 702
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7708
Mailing Address - Country:US
Mailing Address - Phone:443-725-4930
Mailing Address - Fax:
Practice Address - Street 1:1441 AVOCADO AVE STE 702
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7708
Practice Address - Country:US
Practice Address - Phone:949-706-7886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR186416363LA2200X
CA95003122363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health