Provider Demographics
NPI:1376980763
Name:CHRISTOPHER, MICHELLE CYMARA (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CYMARA
Last Name:CHRISTOPHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:CYMARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3552 SMITH DR
Mailing Address - Street 2:APT 16
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-2382
Mailing Address - Country:US
Mailing Address - Phone:607-280-6543
Mailing Address - Fax:
Practice Address - Street 1:516 SOUTH WAY
Practice Address - Street 2:
Practice Address - City:NEWFIELD
Practice Address - State:NY
Practice Address - Zip Code:14867-9023
Practice Address - Country:US
Practice Address - Phone:607-280-6543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-27
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308188164W00000X
NY893032163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse