Provider Demographics
NPI:1073093308
Name:PROCOPIO, MICHELLE LYNNE (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNNE
Last Name:PROCOPIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNNE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:296 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-1576
Mailing Address - Country:US
Mailing Address - Phone:607-738-1520
Mailing Address - Fax:
Practice Address - Street 1:9579 VOCATIONAL DR
Practice Address - Street 2:
Practice Address - City:PAINTED POST
Practice Address - State:NY
Practice Address - Zip Code:14870-9043
Practice Address - Country:US
Practice Address - Phone:607-739-3581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY447378163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse