Provider Demographics
NPI:1871839035
Name:SLOWICK, NIKOLE L (PA)
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:L
Last Name:SLOWICK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NIKOLE
Other - Middle Name:L
Other - Last Name:DELAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 PARK ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4447
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:102 PARK ST
Practice Address - Street 2:CR WOOD CANCER CENTER
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-926-6620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016081363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant