Healthcare Provider Details

I. General information

NPI: 1912749359
Provider Name (Legal Business Name): MARIA MICELI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 12112
ALBANY NY
12212-2112
US

IV. Provider business mailing address

PO BOX 12112
ALBANY NY
12212-2112
US

V. Phone/Fax

Practice location:
  • Phone: 518-549-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number678690-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: