Provider Demographics
NPI:1316370893
Name:PALLATERI, NICOLE LYN (RN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYN
Last Name:PALLATERI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYN
Other - Last Name:PALLATERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2502
Mailing Address - Country:US
Mailing Address - Phone:631-335-0379
Mailing Address - Fax:
Practice Address - Street 1:6 BROADWAY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2502
Practice Address - Country:US
Practice Address - Phone:631-335-0379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY673674163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse