Provider Demographics
NPI:1063583847
Name:TALERICO, MICHELE (FNP)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:TALERICO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:STEWART-DONATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:500 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1620
Mailing Address - Country:US
Mailing Address - Phone:607-687-3241
Mailing Address - Fax:607-687-4725
Practice Address - Street 1:500 5TH AVE
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1620
Practice Address - Country:US
Practice Address - Phone:607-687-3241
Practice Address - Fax:607-687-4725
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330374363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC8457Medicare ID - Type Unspecified
R88832Medicare UPIN