Provider Demographics
NPI:1760503387
Name:TURNER, MICHELLE (CPNP, IBCLC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:CPNP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 OLD COUNTRY RD STE C
Mailing Address - Street 2:STE. 159
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4936
Mailing Address - Country:US
Mailing Address - Phone:516-502-5255
Mailing Address - Fax:886-253-3425
Practice Address - Street 1:998 OLD COUNTRY RD STE C
Practice Address - Street 2:STE. 159
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4936
Practice Address - Country:US
Practice Address - Phone:516-502-5255
Practice Address - Fax:886-253-3425
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381122363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02197473Medicaid