Provider Demographics
NPI:1932332590
Name:BORN, MICHELE TERESA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:TERESA
Last Name:BORN
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 1:1552 SCHLEGEL RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8506
Mailing Address - Country:US
Mailing Address - Phone:585-705-8600
Mailing Address - Fax:
Practice Address - Street 1:1552 SCHLEGEL RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-8506
Practice Address - Country:US
Practice Address - Phone:585-705-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY678078163W00000X
NY292002164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse