Provider Demographics
NPI:1679838817
Name:NICKEL, FELISA VICTORIA
Entity Type:Individual
Prefix:MS
First Name:FELISA
Middle Name:VICTORIA
Last Name:NICKEL
Suffix:
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 1:97 DAWSON CIR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3824
Mailing Address - Country:US
Mailing Address - Phone:718-816-3513
Mailing Address - Fax:
Practice Address - Street 1:97 DAWSON CIR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3824
Practice Address - Country:US
Practice Address - Phone:718-816-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator