Provider Demographics
NPI:1750711412
Name:WAXMAN, NICOLE ANNE (NP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNE
Last Name:WAXMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:ANNE
Other - Last Name:MARETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:ONE PENN PLAZA, 8TH FLOOR
Mailing Address - Street 2:OPTUM
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10119-0002
Mailing Address - Country:US
Mailing Address - Phone:347-395-7493
Mailing Address - Fax:844-428-4577
Practice Address - Street 1:ONE PENN PLAZA, 8TH FLOOR
Practice Address - Street 2:OPTUM
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119-0002
Practice Address - Country:US
Practice Address - Phone:516-799-0210
Practice Address - Fax:516-799-0247
Is Sole Proprietor?:No
Enumeration Date:2013-11-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307697-1363LA2200X
NJ26NJ00472700363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health