Provider Demographics
NPI:1215718531
Name:RECA, MICHELLE LYN (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYN
Last Name:RECA
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 1:7 IVY HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-1233
Mailing Address - Country:US
Mailing Address - Phone:401-255-6709
Mailing Address - Fax:
Practice Address - Street 1:360 KINGSTOWN RD UNIT 101
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3258
Practice Address - Country:US
Practice Address - Phone:401-789-6492
Practice Address - Fax:401-783-9448
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN66841163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse