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Individual
MICHAELLE JEAN
Active
Individual
MICHAELLE JEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
317703-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0129070623
—
NY
01
—
1234567890
MEDICAID , MEDICARE
—
Enumeration date
08/06/2015
Last updated
08/13/2015
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