Provider Demographics
NPI:1043676315
Name:VORISEK, NICOLETTE HEATHER
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:HEATHER
Last Name:VORISEK
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 1:62 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1316
Mailing Address - Country:US
Mailing Address - Phone:631-320-6735
Mailing Address - Fax:
Practice Address - Street 1:62 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1316
Practice Address - Country:US
Practice Address - Phone:631-320-6735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-02
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314995-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse