Provider Demographics
NPI:1750904835
Name:NUNEZ, NERCI ELVIRA
Entity type:Individual
Prefix:
First Name:NERCI
Middle Name:ELVIRA
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NERCI
Other - Middle Name:ELVIRA
Other - Last Name:URBAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:364 S BUCKHOUT ST
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:10533-2205
Mailing Address - Country:US
Mailing Address - Phone:914-806-0441
Mailing Address - Fax:
Practice Address - Street 1:364 S BUCKHOUT ST
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-2205
Practice Address - Country:US
Practice Address - Phone:914-806-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123387164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY123387Medicaid