Provider Demographics
NPI:1255097036
Name:LOCICERO, PHILIP VINCENT (RN)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:VINCENT
Last Name:LOCICERO
Suffix:
Gender:M
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 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2609
Mailing Address - Country:US
Mailing Address - Phone:631-681-0861
Mailing Address - Fax:
Practice Address - Street 1:330 LONG POND RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2609
Practice Address - Country:US
Practice Address - Phone:631-681-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2316062163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical