Provider Demographics
NPI:1982042560
Name:ESTLER, NICOLE LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:ESTLER
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 1:220 VETERANS HWY
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2420
Mailing Address - Country:US
Mailing Address - Phone:631-979-0922
Mailing Address - Fax:631-360-3851
Practice Address - Street 1:220 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2420
Practice Address - Country:US
Practice Address - Phone:631-979-0922
Practice Address - Fax:631-360-3851
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271086-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse