Provider Demographics
NPI:1295169894
Name:MIKE, YVETTE MICHELLE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:MICHELLE
Last Name:MIKE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GAYNOR AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2024
Mailing Address - Country:US
Mailing Address - Phone:315-414-7672
Mailing Address - Fax:
Practice Address - Street 1:107 GAYNOR AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2024
Practice Address - Country:US
Practice Address - Phone:315-414-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421972163WR0400X, 163WW0000X, 163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health