Healthcare Provider Details

I. General information

NPI: 1942943949
Provider Name (Legal Business Name): MICHELLE LOUISE YABLONSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 S 4TH ST
FULTON NY
13069-1859
US

IV. Provider business mailing address

167 S 4TH ST
FULTON NY
13069-1859
US

V. Phone/Fax

Practice location:
  • Phone: 315-963-4308
  • Fax: 315-963-4209
Mailing address:
  • Phone: 315-963-4308
  • Fax: 315-963-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number557520-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: