Provider Demographics
NPI:1467799833
Name:JOSEPH-WISE, NICOLE AMBER (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:AMBER
Last Name:JOSEPH-WISE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 LINDEN BLVD APT 64B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3321
Mailing Address - Country:US
Mailing Address - Phone:718-287-0957
Mailing Address - Fax:718-287-0957
Practice Address - Street 1:95 LINDEN BLVD APT 64B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3321
Practice Address - Country:US
Practice Address - Phone:718-287-0957
Practice Address - Fax:718-287-0957
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305696-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse