Provider Demographics
NPI:1578860953
Name:CROSSLEY, MICHELLE JACQULINE (LVN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JACQULINE
Last Name:CROSSLEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1786 SPYGLASS CIR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-8950
Mailing Address - Country:US
Mailing Address - Phone:760-917-5234
Mailing Address - Fax:
Practice Address - Street 1:1786 SPYGLASS CIR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-8950
Practice Address - Country:US
Practice Address - Phone:760-917-5234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN211710164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse