Provider Demographics
NPI:1235672452
Name:PUTNAM, MICHELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:PUTNAM
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 1:25 CHIPPENHAM DR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1909
Mailing Address - Country:US
Mailing Address - Phone:585-474-5503
Mailing Address - Fax:
Practice Address - Street 1:1548 SCHLEGEL RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-8506
Practice Address - Country:US
Practice Address - Phone:585-265-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-19
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY508047-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool