Provider Demographics
NPI:1891453817
Name:LUCIDI, MICHELLE R (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:LUCIDI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HILLTOWNE DR
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3147
Mailing Address - Country:US
Mailing Address - Phone:860-805-5193
Mailing Address - Fax:
Practice Address - Street 1:3 HILLTOWNE DR
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-3147
Practice Address - Country:US
Practice Address - Phone:860-805-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY715997-01163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice