Active NPI
Michaela Loyola Trudeau
- Licensed Practical Nurse
- Fort Ann, NY
National Provider Identifier
1346586609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 311791
- Practice address
- 3402 State Route 196
Fort Ann, NY 12827-3706 - Phone
- (518) 744-2047
- NPI assigned
- Dec 13, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 311791 | NY | Primary |
Addresses
Primary practice location
3402 State Route 196
Fort Ann, NY 12827-3706
Mailing address
3402 State Route 196
Fort Ann, NY 12827-3706
Phone (518) 744-2047
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 03534549 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 311791 | NY | MD | Endocrinology, Diabetes & Metabolism Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546905600000",
"number": "1346586609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3402 STATE ROUTE 196",
"city": "FORT ANN",
"state": "NY",
"postal_code": "128273706",
"telephone_number": "518-744-2047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3402 STATE ROUTE 196",
"city": "FORT ANN",
"state": "NY",
"postal_code": "128273706",
"telephone_number": "518-744-2047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRUDEAU",
"first_name": "MICHAELA LOYOLA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-12-13",
"last_updated": "2019-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "311791",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "03534549",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Ann, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.