Provider Demographics
NPI:1922372994
Name:VIKSE, CAROL ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:VIKSE
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 1:330 DURANT AVE
Mailing Address - Street 2:P.S. 53R
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-3030
Mailing Address - Country:US
Mailing Address - Phone:718-980-0555
Mailing Address - Fax:
Practice Address - Street 1:330 DURANT AVE
Practice Address - Street 2:P.S. 53R
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3030
Practice Address - Country:US
Practice Address - Phone:718-980-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY409837-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY409837-1OtherRN LICENSE