Provider Demographics
NPI:1891012761
Name:NEWPORT, NICHOLE KARINTHA (LPN)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:KARINTHA
Last Name:NEWPORT
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 1:149 ELLICOTT ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2045
Mailing Address - Country:US
Mailing Address - Phone:585-474-3642
Mailing Address - Fax:
Practice Address - Street 1:149 ELLICOTT ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-2045
Practice Address - Country:US
Practice Address - Phone:585-474-3642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286521164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse