Provider Demographics
NPI:1790975654
Name:TINKHAM, MICHELLE ROVENA (RNFA)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ROVENA
Last Name:TINKHAM
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 SYCAMORE CANYON BLVD
Mailing Address - Street 2:#152
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-8451
Mailing Address - Country:US
Mailing Address - Phone:661-805-5929
Mailing Address - Fax:951-848-0623
Practice Address - Street 1:5925 SYCAMORE CANYON BLVD
Practice Address - Street 2:#152
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-8451
Practice Address - Country:US
Practice Address - Phone:661-805-5929
Practice Address - Fax:951-848-0623
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559981163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant