Provider Demographics
NPI:1194069575
Name:MICHEL, LINDA RENEE (LPN)
Entity type:Individual
Prefix:MISS
First Name:LINDA
Middle Name:RENEE
Last Name:MICHEL
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 1:77A ELYSIAN AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4333
Mailing Address - Country:US
Mailing Address - Phone:845-776-0861
Mailing Address - Fax:
Practice Address - Street 1:77A ELYSIAN AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-4333
Practice Address - Country:US
Practice Address - Phone:845-776-0861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-25
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312087-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse