Provider Demographics
NPI:1841626736
Name:MICHEO, MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MICHEO
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 1:238 PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:PINE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10969-1328
Mailing Address - Country:US
Mailing Address - Phone:917-553-3525
Mailing Address - Fax:
Practice Address - Street 1:238 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:PINE ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10969-1328
Practice Address - Country:US
Practice Address - Phone:917-553-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315274-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse