Provider Demographics
NPI:1326337171
Name:KIRSCHNER, MIKELLE LARA (RN)
Entity Type:Individual
Prefix:
First Name:MIKELLE
Middle Name:LARA
Last Name:KIRSCHNER
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 1:22 FOXWOOD RD
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1011
Mailing Address - Country:US
Mailing Address - Phone:516-293-6063
Mailing Address - Fax:
Practice Address - Street 1:22 FOXWOOD RD
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1011
Practice Address - Country:US
Practice Address - Phone:516-293-6063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY508787-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse