Michiyo Pestridge

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

649508-1 Issued in NY

Practice address

3277 Phillips Rd
Marathon, NY 13803-2139

Phone

(607) 849-3545

NPI assigned

Aug 10, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378425600000",
    "number": "1407048747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3277 PHILLIPS RD",
            "city": "MARATHON",
            "state": "NY",
            "postal_code": "138032139",
            "telephone_number": "607-849-3545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3277 PHILLIPS RD",
            "city": "MARATHON",
            "state": "NY",
            "postal_code": "138032139",
            "telephone_number": "607-849-3545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PESTRIDGE",
        "first_name": "MICHIYO",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-10",
        "last_updated": "2013-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "239691-1",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "649508-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terrissa Coretta Martin, M.D.
• Melissa S Maxson-Mattern, RN
• Natalia Lynne McCormick, NP
• Kathleen Ann Meadows, L.P.N.
• Elizabeth A. Penrose, LMT
• Jeanie L Phillips
• Douglas Andrew Rahner
• Bridget R Savory
• Michael Christopher Secallus, FNP
• Stacy M Soda, MS, CCC-SLP

• All providers in Marathon, NY
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.