Provider Demographics
NPI:1396953352
Name:COVELUSKY, MICHELE A (LPN, NCBTMB)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:A
Last Name:COVELUSKY
Suffix:
Gender:F
Credentials:LPN, NCBTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PARK PLZ
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1398
Mailing Address - Country:US
Mailing Address - Phone:610-685-0450
Mailing Address - Fax:
Practice Address - Street 1:4 PARK PLZ
Practice Address - Street 2:SUITE 302
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1398
Practice Address - Country:US
Practice Address - Phone:610-685-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN095523-L164W00000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist