Provider Demographics
NPI:1053779074
Name:MICHAUD, NICOLE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 E SENECA TPKE
Mailing Address - Street 2:APT C21
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2618
Mailing Address - Country:US
Mailing Address - Phone:315-439-6981
Mailing Address - Fax:
Practice Address - Street 1:685 E SENECA TPKE
Practice Address - Street 2:APT C21
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2618
Practice Address - Country:US
Practice Address - Phone:315-439-6981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318186-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse