Provider Demographics
NPI:1780148510
Name:EGGLESTON, MICHELE (RN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 OAKBRANCH DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4736
Mailing Address - Country:US
Mailing Address - Phone:760-525-4097
Mailing Address - Fax:
Practice Address - Street 1:2080 MISSION AVE
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-2325
Practice Address - Country:US
Practice Address - Phone:760-966-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA273662163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA150118272OtherSCHOOL NURSE CREDENTIAL