Healthcare Provider Details

I. General information

NPI: 1285409995
Provider Name (Legal Business Name): MICHELE LYNN CORSEY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 11/22/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BERLIN CENTRAL SCHOOL DISTRICT 1740 ROUTE 22
CHERRY PLAIN NY
12022
US

IV. Provider business mailing address

1740 ROUTE 22
CHERRY PLAIN NY
12022
US

V. Phone/Fax

Practice location:
  • Phone: 518-658-1500
  • Fax: 518-658-0483
Mailing address:
  • Phone: 518-658-1500
  • Fax: 518-658-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number655543
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: