Provider Demographics
NPI:1255360939
Name:TELGA, MICHELE LYNNE (WHNPC)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNNE
Last Name:TELGA
Suffix:
Gender:F
Credentials:WHNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6668 4TH SECTION ROAD
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420
Mailing Address - Country:US
Mailing Address - Phone:585-637-2670
Mailing Address - Fax:585-637-3678
Practice Address - Street 1:6668 4TH SECTION ROAD
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420
Practice Address - Country:US
Practice Address - Phone:585-637-2670
Practice Address - Fax:585-637-3678
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420307363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02377360Medicaid
NYRA0120-GRP:BA0017Medicare PIN
NYCC3880-GRP:70008AMedicare PIN
NY02377360Medicaid