Provider Demographics
NPI:1710192190
Name:WEGHORST, MICHELLE MEASHIA (LPN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MEASHIA
Last Name:WEGHORST
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 1:94 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2248
Mailing Address - Country:US
Mailing Address - Phone:516-607-3848
Mailing Address - Fax:
Practice Address - Street 1:16 HELEN MARIE PL
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4721
Practice Address - Country:US
Practice Address - Phone:631-234-0209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249456164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse