Provider Demographics
NPI:1619629359
Name:MICHELENA, AMY LEONE (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LEONE
Last Name:MICHELENA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:RICHINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2219 S HACIENDA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-4610
Mailing Address - Country:US
Mailing Address - Phone:626-961-2461
Mailing Address - Fax:626-330-5392
Practice Address - Street 1:2219 S HACIENDA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-4610
Practice Address - Country:US
Practice Address - Phone:626-961-2461
Practice Address - Fax:626-330-5392
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95019515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF95019515OtherFURNISHING LICENSE