Provider Demographics
NPI:1992934251
Name:HEDRICK, MICHELE ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ANN
Last Name:HEDRICK
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 1:289 N GREECE RD
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-8973
Mailing Address - Country:US
Mailing Address - Phone:585-615-5096
Mailing Address - Fax:
Practice Address - Street 1:289 N GREECE RD
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-8973
Practice Address - Country:US
Practice Address - Phone:585-615-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283663-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse