Provider Demographics
NPI:1568868719
Name:LOUIS, NICHOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:
Last Name:LOUIS
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 1:434 STATE ROUTE 374
Mailing Address - Street 2:
Mailing Address - City:CADYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12918-2411
Mailing Address - Country:US
Mailing Address - Phone:518-565-4848
Mailing Address - Fax:
Practice Address - Street 1:133 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2926
Practice Address - Country:US
Practice Address - Phone:518-565-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY484185163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse