Provider Demographics
NPI:1588907893
Name:PANLILIO, MICHELLE TRICIA (MSN, RNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TRICIA
Last Name:PANLILIO
Suffix:
Gender:F
Credentials:MSN, RNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 16TH ST
Mailing Address - Street 2:#206
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1235
Mailing Address - Country:US
Mailing Address - Phone:310-319-3222
Mailing Address - Fax:310-319-4141
Practice Address - Street 1:1245 16TH ST
Practice Address - Street 2:#206
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1235
Practice Address - Country:US
Practice Address - Phone:310-319-3222
Practice Address - Fax:310-319-4141
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 15979363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHM304ZMedicare PIN