Provider Demographics
NPI:1083135875
Name:MICHEL, GRACE MARGARET (FNP)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:MARGARET
Last Name:MICHEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:GRACE
Other - Middle Name:MARGARET
Other - Last Name:FALLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3 BARBARA LN
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2204
Mailing Address - Country:US
Mailing Address - Phone:315-427-9181
Mailing Address - Fax:
Practice Address - Street 1:195 INTREPID LN
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2548
Practice Address - Country:US
Practice Address - Phone:315-469-8700
Practice Address - Fax:315-469-6789
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3418861363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health