Individual
MICAELLE RESERVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
50 CLINTON ST, HEMPSTEAD, NY 11550-4281
(516) 933-0485
Mailing address
59 CLINTON STREET, HEAMPSTEAD, NY 11550
(516) 933-0485
(516) 933-1923
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
776983
NY
164W00000X
Licensed Practical Nurse
317658-1
NY
Other
Enumeration date
01/31/2014
Last updated
08/26/2019
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