Provider Demographics
NPI:1518348382
Name:WARD, MICHELLE (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WARD
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 1:6746 PINE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GLENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13343-1811
Mailing Address - Country:US
Mailing Address - Phone:315-377-3076
Mailing Address - Fax:
Practice Address - Street 1:7518 S STATE ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1531
Practice Address - Country:US
Practice Address - Phone:315-376-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290597-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse