Provider Demographics
NPI:1861797334
Name:CALIXTE, MICHELLE MARIE (NURSE)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:CALIXTE
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13932 254TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2616
Mailing Address - Country:US
Mailing Address - Phone:718-276-6482
Mailing Address - Fax:
Practice Address - Street 1:13932 254TH ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2616
Practice Address - Country:US
Practice Address - Phone:718-276-6482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300671-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse