1255118550 NPI number — MRS. MICHELLE JACQUELINE NOXSEL NP

Table of content: MRS. MICHELLE JACQUELINE NOXSEL NP (NPI 1255118550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255118550 NPI number — MRS. MICHELLE JACQUELINE NOXSEL NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOXSEL
Provider First Name:
MICHELLE
Provider Middle Name:
JACQUELINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOWE
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
JACQUELINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255118550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 N SEE VEE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISHOP
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93514-8130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-873-8461
Provider Business Mailing Address Fax Number:
760-503-4174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44B N TU SU LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISHOP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93514-8058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-873-7611
Provider Business Practice Location Address Fax Number:
760-503-4174
Provider Enumeration Date:
09/11/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WG0000X , with the licence number:  95088369 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 95019662 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: THP11576F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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