Provider Demographics
NPI:1598861825
Name:CHERY-MOMPREMIER, NICA (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:NICA
Middle Name:
Last Name:CHERY-MOMPREMIER
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:82-68 164TH STREET PAVILION ROOM 113
Mailing Address - Street 2:QUEENS HOSPITAL CENTER
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-883-4500
Mailing Address - Fax:718-883-6106
Practice Address - Street 1:87-41 PARSONS BLVD ROOM 102
Practice Address - Street 2:SCHOOL BOARD HEALTH CLINIC P.S86
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-526-3589
Practice Address - Fax:718-297-0298
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-08-07
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Provider Licenses
StateLicense IDTaxonomies
NYF380927363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00330231Medicare ID - Type Unspecified