Provider Demographics
NPI:1801638572
Name:BROWN, MICHELLE L (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BROWN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:HACKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:84 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CANISTEO
Mailing Address - State:NY
Mailing Address - Zip Code:14823-1230
Mailing Address - Country:US
Mailing Address - Phone:607-698-4225
Mailing Address - Fax:607-698-2325
Practice Address - Street 1:84 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:CANISTEO
Practice Address - State:NY
Practice Address - Zip Code:14823-1230
Practice Address - Country:US
Practice Address - Phone:607-698-4225
Practice Address - Fax:607-698-2325
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY389893163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse