MEDICARE: MISS MICHELLE THERESA ONWUALU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	239110	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265576367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELLE THERESA ONWUALU

Provider Business Mailing Address
First Line	:	115-112 220TH STREET
Second Line	:
City	:	CAMBRIA HTS
State	:	NY
Zip	:	11411
Country	:	US
Telephone Number	:	718-276-4101
Fax Number	:	718-276-1331

Provider Business Practice Location Address
First Line	:	115112 220TH ST
Second Line	:
City	:	CAMBRIA HTS
State	:	NY
Zip	:	11411-1161
Country	:	US
Telephone Number	:	718-276-4101
Fax Number	:	718-276-1331

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/09/2007

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