Provider Demographics
NPI:1336589209
Name:MICHEL, CLIFFORD (LPN)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:
Last Name:MICHEL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4521
Mailing Address - Country:US
Mailing Address - Phone:347-687-7363
Mailing Address - Fax:
Practice Address - Street 1:40 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4521
Practice Address - Country:US
Practice Address - Phone:347-687-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314330164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse