Provider Demographics
NPI:1598291056
Name:PHILISTIN, NERCIE JR
Entity Type:Individual
Prefix:
First Name:NERCIE
Middle Name:
Last Name:PHILISTIN
Suffix:JR
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 1:347 BEACH 47TH ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-1116
Mailing Address - Country:US
Mailing Address - Phone:410-251-1970
Mailing Address - Fax:
Practice Address - Street 1:347 BEACH 47TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-1116
Practice Address - Country:US
Practice Address - Phone:410-251-1970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY727918163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse