Provider Demographics
NPI:1700159290
Name:PRONTI-DEYOUNG, MICHELE A (RN)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:PRONTI-DEYOUNG
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 1:101 CARTER RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1053
Mailing Address - Country:US
Mailing Address - Phone:315-781-4164
Mailing Address - Fax:
Practice Address - Street 1:101 CARTER RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1053
Practice Address - Country:US
Practice Address - Phone:315-781-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY646756163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool