Provider Demographics
NPI:1003203266
Name:SEVERE, PRISCILLA A (RN(REGISTERED NURSE))
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:A
Last Name:SEVERE
Suffix:
Gender:F
Credentials:RN(REGISTERED NURSE)
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:A
Other - Last Name:SEVERE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN (REGISTERED NURSE
Mailing Address - Street 1:9 WEST PROSPECT AVENUE, SUITE 310
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550
Mailing Address - Country:US
Mailing Address - Phone:914-699-0022
Mailing Address - Fax:914-699-2154
Practice Address - Street 1:9 WEST PROSPECT AVENUE, SUITE 310
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550
Practice Address - Country:US
Practice Address - Phone:914-699-0022
Practice Address - Fax:914-699-2154
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315747164W00000X
NY701089-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse