Provider Demographics
NPI:1215288477
Name:CIARAVELLA, MICHELLE ROSE (LPN)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ROSE
Last Name:CIARAVELLA
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 1:842 LAKEVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-5740
Mailing Address - Country:US
Mailing Address - Phone:631-255-6167
Mailing Address - Fax:
Practice Address - Street 1:842 LAKEVILLE CIR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-5740
Practice Address - Country:US
Practice Address - Phone:631-255-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY366267146M00000X
NY311777164W00000X
CA292876164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No164W00000XNursing Service ProvidersLicensed Practical Nurse