Provider Demographics
NPI:1396069639
Name:DAIGLE, MICHELLE KAREN (LPN)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:KAREN
Last Name:DAIGLE
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 1:7299 STATE ROUTE 149
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12832-3312
Mailing Address - Country:US
Mailing Address - Phone:518-642-9507
Mailing Address - Fax:518-642-8191
Practice Address - Street 1:7299 STATE ROUTE 149
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-3312
Practice Address - Country:US
Practice Address - Phone:518-642-9507
Practice Address - Fax:518-642-8191
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250868164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse