MEDICARE: MICHELE M DOYLE

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	363LF0000X	Family Nurse Practitioner	F337610	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	:	1902344492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELE M DOYLE

Provider Business Mailing Address
First Line	:	32 CANAL ST
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-1638
Country	:	US
Telephone Number	:	845-856-6671
Fax Number	:	845-858-9903

Provider Business Practice Location Address
First Line	:	32 CANAL ST
Second Line	:
City	:	PORT JERVIS
State	:	NY
Zip	:	12771-1638
Country	:	US
Telephone Number	:	845-856-6671
Fax Number	:	845-858-9903

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELE M DOYLE
Credential	:	FNP-BC
Telephone Number	:	845-856-6671

Provider Enumeration Date	:	02/06/2017
Last Update Date	:	03/28/2017

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