Provider Demographics
NPI:1982894135
Name:MICHAELS, CARMEN ELAINE (NP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ELAINE
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48677 VICTORIA LN
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-9216
Mailing Address - Country:US
Mailing Address - Phone:559-683-2711
Mailing Address - Fax:559-683-0672
Practice Address - Street 1:48677 VICTORIA LN
Practice Address - Street 2:SUITE 201B
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9216
Practice Address - Country:US
Practice Address - Phone:559-683-2711
Practice Address - Fax:559-683-0672
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17245NP363LF0000X
WY25471363LF0000X
CA17245363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025540500Medicaid
CO21602069Medicaid
NE10025540500Medicaid