Provider Demographics
NPI:1003390451
Name:MOREY, MICHELE SMITH (LPNN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:SMITH
Last Name:MOREY
Suffix:
Gender:F
Credentials:LPNN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4476 RT 38
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827
Mailing Address - Country:US
Mailing Address - Phone:607-662-5692
Mailing Address - Fax:
Practice Address - Street 1:4476 RT38
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827
Practice Address - Country:US
Practice Address - Phone:607-662-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190151-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse