Provider Demographics
NPI:1053029892
Name:ARTISTA, MICHELLE JADE
Entity type:Individual
Prefix:
First Name:MICHELLE JADE
Middle Name:
Last Name:ARTISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 W 13TH AVE APT 121
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3484
Mailing Address - Country:US
Mailing Address - Phone:541-554-5335
Mailing Address - Fax:
Practice Address - Street 1:3655 W 13TH AVE APT 121
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3484
Practice Address - Country:US
Practice Address - Phone:541-554-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202110740LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse