MEDICARE: MICHAELA LOYOLA TRUDEAU

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	311791	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	:	1346586609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA LOYOLA TRUDEAU

Provider Business Mailing Address
First Line	:	3402 STATE ROUTE 196
Second Line	:
City	:	FORT ANN
State	:	NY
Zip	:	12827-3706
Country	:	US
Telephone Number	:	518-744-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	3402 STATE ROUTE 196
Second Line	:
City	:	FORT ANN
State	:	NY
Zip	:	12827-3706
Country	:	US
Telephone Number	:	518-744-2047
Fax Number	:

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

Provider Enumeration Date	:	12/13/2012
Last Update Date	:	01/08/2019

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