Provider Demographics
NPI:1851893200
Name:VICKERS, ESTHER WILMA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:WILMA
Last Name:VICKERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1022
Mailing Address - Country:US
Mailing Address - Phone:631-789-1004
Mailing Address - Fax:
Practice Address - Street 1:65 WALNUT RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1022
Practice Address - Country:US
Practice Address - Phone:631-789-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282140-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY227028127Medicaid