Provider Demographics
NPI:1609416205
Name:DE YNCHAUSTI, MICHELLE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:DE YNCHAUSTI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43839 15TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4756
Mailing Address - Country:US
Mailing Address - Phone:661-945-5984
Mailing Address - Fax:661-951-3355
Practice Address - Street 1:42135 10TH ST W STE 201
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-6093
Practice Address - Country:US
Practice Address - Phone:661-341-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013588363LF0000X
TX143942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily