Provider Demographics
NPI:1003063041
Name:WELDON, MICHELE LYNNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LYNNE
Last Name:WELDON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:LYNNE
Other - Last Name:CLARK/SCHMUTZLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:976 CONNERS RD
Mailing Address - Street 2:
Mailing Address - City:CAYUGA
Mailing Address - State:NY
Mailing Address - Zip Code:13034-2133
Mailing Address - Country:US
Mailing Address - Phone:315-889-7112
Mailing Address - Fax:
Practice Address - Street 1:976 CONNERS RD
Practice Address - Street 2:
Practice Address - City:CAYUGA
Practice Address - State:NY
Practice Address - Zip Code:13034-2133
Practice Address - Country:US
Practice Address - Phone:315-889-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255723-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse