Provider Demographics
NPI:1194298372
Name:BLOCK, MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BLOCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:SIKORA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:200 HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 HOLLY DR
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-2030
Practice Address - Country:US
Practice Address - Phone:267-644-5347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN693526163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse