Provider Demographics
NPI:1346966645
Name:NICKELS, KARI
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:NICKELS
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 1:2 HICKORY WAY
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-3672
Mailing Address - Country:US
Mailing Address - Phone:609-306-3410
Mailing Address - Fax:
Practice Address - Street 1:135 DEER PARK AVE APT 2C
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2818
Practice Address - Country:US
Practice Address - Phone:609-306-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY828420-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJYKZ3HZN40520220OtherBLUE CROSS BLUE SHIELD