Provider Demographics
NPI:1427390939
Name:BROWN, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BROWN
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 1:16215 HIGHLAND AVE
Mailing Address - Street 2:APT 3N
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3452
Mailing Address - Country:US
Mailing Address - Phone:347-665-8628
Mailing Address - Fax:
Practice Address - Street 1:16215 HIGHLAND AVE
Practice Address - Street 2:APT 3N
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3452
Practice Address - Country:US
Practice Address - Phone:347-665-8628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY650028163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse