Provider Demographics
NPI:1376059402
Name:ROYLE, MICHELE DIANE (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:DIANE
Last Name:ROYLE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NY
Mailing Address - Zip Code:13076-3192
Mailing Address - Country:US
Mailing Address - Phone:315-532-0635
Mailing Address - Fax:
Practice Address - Street 1:171 CORNELL RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NY
Practice Address - Zip Code:13076-3192
Practice Address - Country:US
Practice Address - Phone:315-532-0635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316378-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse