Provider Demographics
NPI:1548680374
Name:GARCIA, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GARCIA
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 1:1747 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:PIFFARD
Mailing Address - State:NY
Mailing Address - Zip Code:14533-9734
Mailing Address - Country:US
Mailing Address - Phone:585-919-9332
Mailing Address - Fax:
Practice Address - Street 1:1747 GENESEE ST
Practice Address - Street 2:
Practice Address - City:PIFFARD
Practice Address - State:NY
Practice Address - Zip Code:14533-9734
Practice Address - Country:US
Practice Address - Phone:585-919-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-19
Last Update Date:2014-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY604007163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse