Provider Demographics
NPI:1063005387
Name:FLEMING, NICOLE ERIN (RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ERIN
Last Name:FLEMING
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 1:30 PARK AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-2452
Mailing Address - Country:US
Mailing Address - Phone:978-894-5496
Mailing Address - Fax:
Practice Address - Street 1:30 PARK AVE APT 4
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-2452
Practice Address - Country:US
Practice Address - Phone:978-894-5496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY802364-01163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics