Provider Demographics
NPI:1588497770
Name:IMBRUGLIA, MICHELLE ROSE (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ROSE
Last Name:IMBRUGLIA
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-5128
Mailing Address - Country:US
Mailing Address - Phone:914-262-0584
Mailing Address - Fax:
Practice Address - Street 1:105 S BEDFORD RD STE 305
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3450
Practice Address - Country:US
Practice Address - Phone:914-241-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYFA21779363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health