Provider Demographics
NPI:1114211646
Name:KINGSLEY, NUNICHU B (LPN,RN)
Entity Type:Individual
Prefix:
First Name:NUNICHU
Middle Name:B
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:LPN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 E 214TH ST
Mailing Address - Street 2:APT-4B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5914
Mailing Address - Country:US
Mailing Address - Phone:718-671-2100
Mailing Address - Fax:
Practice Address - Street 1:846 E 214TH ST
Practice Address - Street 2:APT-4B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5914
Practice Address - Country:US
Practice Address - Phone:718-671-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305544164W00000X
NY672702163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse