Healthcare Provider Details

I. General information

NPI: 1760503387
Provider Name (Legal Business Name): MICHELLE TURNER C.P.N.P., I.B.C.L.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 OLD COUNTRY RD STE C STE. 159
PLAINVIEW NY
11803-4936
US

IV. Provider business mailing address

998 OLD COUNTRY RD STE C STE. 159
PLAINVIEW NY
11803-4936
US

V. Phone/Fax

Practice location:
  • Phone: 516-502-5255
  • Fax: 886-253-3425
Mailing address:
  • Phone: 516-502-5255
  • Fax: 886-253-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381122
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier02197473
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: