Michelle Jason

Individual provider Active NPI Licensed Practical Nurse · Sodus, NY

NPI 1659820199 · NPPES record last updated Sep 26, 2016

Key facts

NPI
1659820199
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
283665 (NY)
Practice address
6692 Middle Rd
Suite 2100
Sodus, NY 14551-9602
Phone
(315) 483-1199
Fax
(315) 483-2451
NPI assigned
Sep 26, 2016
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
283665NYMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 283665 NY Yes

Addresses

Primary practice location

6692 Middle Rd
Suite 2100
Sodus, NY 14551-9602

Mailing address

14 Maiden LN
Penn Yan, NY 14527-1208
Phone (315) 531-9102

Other identifiers

IdentifierTypeStateIssuer
283665OtherNYLICENSE

Other providers in Sodus, NY

All providers in Sodus, NY · Licensed Practical Nurse in New York

Sources for this page

Verify at the official NPI Registry.