Provider Demographics
NPI:1033264965
Name:KING, NINA ANGELA (RN)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:ANGELA
Last Name:KING
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:KATANOH
Mailing Address - State:NY
Mailing Address - Zip Code:10536
Mailing Address - Country:US
Mailing Address - Phone:914-232-1236
Mailing Address - Fax:
Practice Address - Street 1:208 HARRIS RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507
Practice Address - Country:US
Practice Address - Phone:914-666-6854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5175471163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01478793Medicaid