Provider Demographics
NPI:1366086266
Name:PERSIN, MICHAEL A (RN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:PERSIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 IRENE DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9008
Mailing Address - Country:US
Mailing Address - Phone:315-263-6151
Mailing Address - Fax:
Practice Address - Street 1:7650 VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9712
Practice Address - Country:US
Practice Address - Phone:315-638-6106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY494519163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool