Provider Demographics
NPI:1467093559
Name:PENNICOTT, YANEIK S (RN)
Entity Type:Individual
Prefix:
First Name:YANEIK
Middle Name:S
Last Name:PENNICOTT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PEARSALL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3945
Mailing Address - Country:US
Mailing Address - Phone:914-513-7764
Mailing Address - Fax:
Practice Address - Street 1:463 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-3441
Practice Address - Country:US
Practice Address - Phone:914-513-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY760303163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse