Provider Demographics
NPI:1033497482
Name:ELIE, MICHELLE ROSALIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ROSALIE
Last Name:ELIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 PAXTON RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-4629
Mailing Address - Country:US
Mailing Address - Phone:585-342-2306
Mailing Address - Fax:
Practice Address - Street 1:53 PAXTON RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14617-4629
Practice Address - Country:US
Practice Address - Phone:585-342-2306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3041121164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse