Provider Demographics
NPI:1679820336
Name:MIANULLI, MICHELE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:MIANULLI
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 1:15 N HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-4120
Mailing Address - Country:US
Mailing Address - Phone:516-779-8694
Mailing Address - Fax:
Practice Address - Street 1:15 N HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4120
Practice Address - Country:US
Practice Address - Phone:516-779-8694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2012-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310914164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse