Provider Demographics
NPI:1205211810
Name:CARD, MICHELE (RN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:CARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:CARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3693 MCGRAW MARATHON RD
Mailing Address - Street 2:
Mailing Address - City:MC GRAW
Mailing Address - State:NY
Mailing Address - Zip Code:13101-9451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 BROWN RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1247
Practice Address - Country:US
Practice Address - Phone:607-274-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY617338-1163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health