Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 420812 | NY |
NPI | 1043353733 |
---|---|
Provider Name | Jennifer Lynn Michalke |
First Address | Springfield, VT 05156-3050 |
Second Address | Springfield, VT 05156-3050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 02/08/2016 |