Provider Demographics
NPI:1790071819
Name:MERMIGAS, MICHELLE DIANNE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:DIANNE
Last Name:MERMIGAS
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 1:88 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-2383
Mailing Address - Country:US
Mailing Address - Phone:631-730-8510
Mailing Address - Fax:
Practice Address - Street 1:88 7TH AVE
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-2383
Practice Address - Country:US
Practice Address - Phone:631-730-8510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301781-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse