Provider Demographics
NPI:1952603839
Name:MICHELS, LORI A (LPN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:MICHELS
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 1:1460 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9546
Mailing Address - Country:US
Mailing Address - Phone:716-947-9477
Mailing Address - Fax:
Practice Address - Street 1:832 BEACH RD
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-9756
Practice Address - Country:US
Practice Address - Phone:716-549-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-26
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272092-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse