Provider Demographics
NPI:1760842710
Name:FOX, MICHELLE DARENE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DARENE
Last Name:FOX
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 E ALISAL ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-2602
Mailing Address - Country:US
Mailing Address - Phone:831-796-2875
Mailing Address - Fax:831-757-7076
Practice Address - Street 1:632 E ALISAL ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2602
Practice Address - Country:US
Practice Address - Phone:831-796-2875
Practice Address - Fax:831-757-7076
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254984163WL0100X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No251S00000XAgenciesCommunity/Behavioral Health