Individual
MS. MICHELLE L CEO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.P.N.P.
Contact information
Practice address
HSC T19-068 NICHOLS RD., STONY BROOK, NY 11794
(631) 444-2045
(631) 444-8862
Mailing address
HSC T19-068 NICHOLS RD., STONY BROOK UNIVERSITY MEDICAL CENTER, STONY BROOK, NY 11794
(631) 444-2045
(631) 444-8862
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
381993
NY
363LP0200X
Pediatric Nurse Practitioner
F381993
NY
Other
Enumeration date
01/04/2009
Last updated
12/12/2013
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