Provider Demographics
NPI:1992007504
Name:OBERMULLER, MICHELLE ALLISON (RN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ALLISON
Last Name:OBERMULLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ALLISON
Other - Last Name:PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13150 224TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1726
Mailing Address - Country:US
Mailing Address - Phone:347-520-8559
Mailing Address - Fax:
Practice Address - Street 1:28-11 QUEENS PLAZA N.
Practice Address - Street 2:4TH FL
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-391-8116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY592161-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse