Michelle Marlys South, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

220999 Issued in CA

Practice address

18285 China Grade Rd
#3
Boulder Creek, CA 95006-9188

Phone

(831) 419-3116

NPI assigned

Jan 10, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326153600000",
    "number": "1699045450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18285 CHINA GRADE RD SPC 3",
            "city": "BOULDER CREEK",
            "state": "CA",
            "postal_code": "950069100",
            "telephone_number": "831-419-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18285 CHINA GRADE RD",
            "address_2": "#3",
            "city": "BOULDER CREEK",
            "state": "CA",
            "postal_code": "950069188",
            "telephone_number": "831-419-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTH",
        "first_name": "MICHELLE",
        "middle_name": "MARLYS",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-10",
        "last_updated": "2012-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "220999",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mayya Sakr
• Mesk Samara
• Alexandra E. Schulthess, ND, BCDNM,CFMP
• Corinne Lyn Seymour, MA, LMFT
• Micah Elizabeth Smith-Khan, M.S., CCC-SLP
• Anna Sramek, RDN
• Stephanie Strudley, MS
• Sulmaan Hassan DDS Inc.
• Ashley Taylor
• Josie Traub, LMFT

• Licensed Vocational Nurse in Boulder Creek, CA
• Providers in Boulder Creek, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.