Provider Demographics
NPI:1497763346
Name:BONCEK, MICHELE GRACE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:GRACE
Last Name:BONCEK
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:PO BOX 90
Mailing Address - Street 2:10 SAWMILL RD
Mailing Address - City:CLARYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12725
Mailing Address - Country:US
Mailing Address - Phone:845-985-7288
Mailing Address - Fax:
Practice Address - Street 1:437 PARKSVILLE RD
Practice Address - Street 2:DAYTOP VILLAGE INC
Practice Address - City:PARKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12768
Practice Address - Country:US
Practice Address - Phone:845-292-6372
Practice Address - Fax:845-292-7330
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2720241163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse