Provider Demographics
NPI:1437021409
Name:KOGO, MICHELE M
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:KOGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1646
Mailing Address - Country:US
Mailing Address - Phone:716-807-3824
Mailing Address - Fax:716-203-5509
Practice Address - Street 1:380 DRAKE DR
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1646
Practice Address - Country:US
Practice Address - Phone:716-807-3824
Practice Address - Fax:716-203-5509
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY487835163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool