MEDICARE: EMILY KATHLEEN MICHAELIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	N41777	NY
2	163W00000X	Registered Nurse	160284	KS

General Provider Information

NPI Number	:	1558291740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY KATHLEEN MICHAELIS

Provider Business Mailing Address
First Line	:	297 MONTGOMERY ST APT 2E
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	297 MONTGOMERY ST APT 2E
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-4033
Country	:	US
Telephone Number	:	316-631-2249
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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