Provider Demographics
NPI:1922754373
Name:LACOURT, NIJAH
Entity Type:Individual
Prefix:
First Name:NIJAH
Middle Name:
Last Name:LACOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 PUTNAM AVE W APT 7K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2477
Mailing Address - Country:US
Mailing Address - Phone:914-359-9548
Mailing Address - Fax:
Practice Address - Street 1:3815 PUTNAM AVE W APT 7K
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2477
Practice Address - Country:US
Practice Address - Phone:914-359-9548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY785350163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0Medicaid