Provider Demographics
NPI:1467718767
Name:NICHOLSON, PATRICIA P (NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:P
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 CRESTON AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4244
Mailing Address - Country:US
Mailing Address - Phone:718-618-0401
Mailing Address - Fax:718-294-6276
Practice Address - Street 1:2024 CRESTON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4244
Practice Address - Country:US
Practice Address - Phone:718-618-0401
Practice Address - Fax:718-294-6276
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337195163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse