Provider Demographics
NPI:1790544526
Name:CAMACHO, NICOLE AGATHA (RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:AGATHA
Last Name:CAMACHO
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 1:670 MIDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5518
Mailing Address - Country:US
Mailing Address - Phone:347-415-3178
Mailing Address - Fax:
Practice Address - Street 1:670 MIDWOOD RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-5518
Practice Address - Country:US
Practice Address - Phone:347-415-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY637965163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse