Provider Demographics
NPI:1811244999
Name:DIEUDONNE, MICALE (LPN)
Entity type:Individual
Prefix:MISS
First Name:MICALE
Middle Name:
Last Name:DIEUDONNE
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 1:16 TRIMBLE ST
Mailing Address - Street 2:PH
Mailing Address - City:GARNERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10923-1508
Mailing Address - Country:US
Mailing Address - Phone:754-234-3498
Mailing Address - Fax:
Practice Address - Street 1:16 TRIMBLE ST
Practice Address - Street 2:
Practice Address - City:GARNERVILLE
Practice Address - State:NY
Practice Address - Zip Code:10923-1508
Practice Address - Country:US
Practice Address - Phone:754-234-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307103-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse