Provider Demographics
NPI:1043441835
Name:BASTIEN, NADINE
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:BASTIEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 DIELLEN LN
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4546
Mailing Address - Country:US
Mailing Address - Phone:516-668-7061
Mailing Address - Fax:866-232-0801
Practice Address - Street 1:1492 DIELLEN LN
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-4546
Practice Address - Country:US
Practice Address - Phone:516-668-7061
Practice Address - Fax:866-232-0801
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264459-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse