Provider Demographics
NPI:1790205334
Name:QUERIM, NIKI MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:NIKI
Middle Name:MARIE
Last Name:QUERIM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 OLD PLANK RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3107
Mailing Address - Country:US
Mailing Address - Phone:518-793-4409
Mailing Address - Fax:
Practice Address - Street 1:9 OLD PLANK RD
Practice Address - Street 2:STE 100
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3107
Practice Address - Country:US
Practice Address - Phone:518-793-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341878-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine