Basic Information
| Provider Information | |||||||||
| NPI: | 1790357382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOKES | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ANGELO | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 508 IMPERIAL HWY APT C | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928351123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144036358 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 679 S NEW HAMPSHIRE AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900051355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136392500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2021 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 700302 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.