Provider Demographics
NPI:1174859193
Name:BARTOSZEWSKI, NICOLE RAYE (MS, RPA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RAYE
Last Name:BARTOSZEWSKI
Suffix:
Gender:F
Credentials:MS, RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:ELLISBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13636-0082
Mailing Address - Country:US
Mailing Address - Phone:315-323-3801
Mailing Address - Fax:
Practice Address - Street 1:103 BARRACKS DR
Practice Address - Street 2:
Practice Address - City:SACKETS HARBOR
Practice Address - State:NY
Practice Address - Zip Code:13685-9530
Practice Address - Country:US
Practice Address - Phone:315-646-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013654363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant