Provider Demographics
NPI:1003305178
Name:POMEROY, NICOLE LEIGH I (NP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEIGH
Last Name:POMEROY
Suffix:I
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2605
Mailing Address - Country:US
Mailing Address - Phone:814-938-3550
Mailing Address - Fax:814-938-3679
Practice Address - Street 1:81 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2605
Practice Address - Country:US
Practice Address - Phone:814-938-3550
Practice Address - Fax:814-938-3679
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN616159163W00000X
PASP018805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse