Provider Demographics
NPI:1609103910
Name:NIZZA, MICHELE DENISE ANDERSON (LM, CPM, CLEC, LCCE)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:DENISE ANDERSON
Last Name:NIZZA
Suffix:
Gender:F
Credentials:LM, CPM, CLEC, LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1872
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942-1872
Mailing Address - Country:US
Mailing Address - Phone:831-238-0655
Mailing Address - Fax:
Practice Address - Street 1:1010 CASS ST STE C3
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4515
Practice Address - Country:US
Practice Address - Phone:831-238-0655
Practice Address - Fax:831-233-6546
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CA374J00000X
CA621176B00000X
CA66221225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No174400000XOther Service ProvidersSpecialist
No374J00000XNursing Service Related ProvidersDoula
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist