Provider Demographics
NPI:1750112819
Name:ROBILLARD, MICHELE DIANE (LPN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:DIANE
Last Name:ROBILLARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 STATE HIGHWAY 58
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:NY
Mailing Address - Zip Code:13635-3158
Mailing Address - Country:US
Mailing Address - Phone:315-212-2003
Mailing Address - Fax:
Practice Address - Street 1:1395 STATE HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:NY
Practice Address - Zip Code:13635-3158
Practice Address - Country:US
Practice Address - Phone:315-212-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133231-01164W00000X, 364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health