Provider Demographics
NPI:1255875118
Name:KINGSTON, MICHELE R (LPN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:R
Last Name:KINGSTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 HAVERFORD AVE
Mailing Address - Street 2:E202
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2938
Mailing Address - Country:US
Mailing Address - Phone:610-349-1143
Mailing Address - Fax:
Practice Address - Street 1:7400 HAVERFORD AVE
Practice Address - Street 2:E202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2938
Practice Address - Country:US
Practice Address - Phone:215-921-9861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA275446164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse