Provider Demographics
NPI:1033180393
Name:NICOTRA, NORMINA (CRNA)
Entity Type:Individual
Prefix:
First Name:NORMINA
Middle Name:
Last Name:NICOTRA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 33RD ST
Mailing Address - Street 2:APT 23E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2828
Mailing Address - Country:US
Mailing Address - Phone:212-922-1443
Mailing Address - Fax:
Practice Address - Street 1:315 W 33RD ST
Practice Address - Street 2:APT 23E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2828
Practice Address - Country:US
Practice Address - Phone:212-922-1443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY494154367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
0432G1Medicare ID - Type Unspecified
Q09692Medicare UPIN