Provider Demographics
NPI:1043594955
Name:BLISS, MICHALINA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHALINA
Middle Name:
Last Name:BLISS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4940
Mailing Address - Country:US
Mailing Address - Phone:315-451-2452
Mailing Address - Fax:
Practice Address - Street 1:720 7TH ST
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4452
Practice Address - Country:US
Practice Address - Phone:315-453-0258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212375-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse