Healthcare Provider Details

I. General information

NPI: 1497831333
Provider Name (Legal Business Name): MICHELE M MCINERNEY RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHAM 3415 BAINBRIDGE AVENUE
BRONX NY
10467
US

IV. Provider business mailing address

87 E 236TH ST
BRONX NY
10470-1917
US

V. Phone/Fax

Practice location:
  • Phone: 718-741-2342
  • Fax:
Mailing address:
  • Phone: 718-741-2342
  • Fax: 718-920-6506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF381616
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: