Provider Demographics
NPI:1306100730
Name:OKONIECZNY, MICHELLE L (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:L
Last Name:OKONIECZNY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:ORTWEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:300 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1118
Mailing Address - Country:US
Mailing Address - Phone:585-637-3905
Mailing Address - Fax:585-637-2375
Practice Address - Street 1:301 WEST AVE
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1522
Practice Address - Country:US
Practice Address - Phone:585-637-3905
Practice Address - Fax:585-637-2375
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily