Provider Demographics
NPI:1568977171
Name:RHOADES, MICHELE LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:RHOADES
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 1:2107 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH COLLINS
Mailing Address - State:NY
Mailing Address - Zip Code:14111
Mailing Address - Country:US
Mailing Address - Phone:716-337-3706
Mailing Address - Fax:716-337-2723
Practice Address - Street 1:2107 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:NORTH COLLINS
Practice Address - State:NY
Practice Address - Zip Code:14111
Practice Address - Country:US
Practice Address - Phone:716-337-3706
Practice Address - Fax:716-337-2723
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236042-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse