Provider Demographics
NPI:1871941732
Name:NEIDER, MICHELLE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:NEIDER
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 1:8094 STATE ROUTE 13
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-4856
Mailing Address - Country:US
Mailing Address - Phone:315-697-6116
Mailing Address - Fax:315-693-0017
Practice Address - Street 1:8094 STATE ROUTE 13
Practice Address - Street 2:
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-4856
Practice Address - Country:US
Practice Address - Phone:315-697-6116
Practice Address - Fax:315-693-0017
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10301396164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse