=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992145973
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE LYNN SILPOCH LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2013
-----------------------------------------------------
Last Update Date | 07/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16741 RIDGE RD
-----------------------------------------------------
City | HOLLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14470-9343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-747-6064
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16741 RIDGE RD
-----------------------------------------------------
City | HOLLEY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14470-9343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-747-6064
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 309986-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------