Provider Demographics
NPI:1528457249
Name:CASANOVA, MICHELLE KATHLEEN RALLECA (FNP)
Entity type:Individual
Prefix:
First Name:MICHELLE KATHLEEN
Middle Name:RALLECA
Last Name:CASANOVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KATHLEEN
Other - Last Name:RALLECA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:655 S. CENTRAL VALLY HWY
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263
Mailing Address - Country:US
Mailing Address - Phone:800-300-6664
Mailing Address - Fax:661-746-9197
Practice Address - Street 1:501 40TH ST STE A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5845
Practice Address - Country:US
Practice Address - Phone:661-391-0305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF0914750363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner