Provider Demographics
NPI:1588806954
Name:AMAZAN, MICHELINE (RN)
Entity Type:Individual
Prefix:
First Name:MICHELINE
Middle Name:
Last Name:AMAZAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELINE
Other - Middle Name:
Other - Last Name:AMAZAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:960 STERLING PL
Mailing Address - Street 2:APT 2L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2551
Mailing Address - Country:US
Mailing Address - Phone:718-807-6979
Mailing Address - Fax:
Practice Address - Street 1:960 STERLING PL
Practice Address - Street 2:APT 2L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2551
Practice Address - Country:US
Practice Address - Phone:718-807-6979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY624552163W00000X
NY350996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse