Provider Demographics
NPI:1669894143
Name:PELAGE, MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PELAGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 186TH ST STE C114
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-2710
Mailing Address - Country:US
Mailing Address - Phone:718-551-6139
Mailing Address - Fax:
Practice Address - Street 1:6143 186TH ST STE C114
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2710
Practice Address - Country:US
Practice Address - Phone:718-551-6139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY528598163WI0500X
NY22 528598163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WC0400XNursing Service ProvidersRegistered NurseCase Management