Provider Demographics
NPI:1831458330
Name:BRACKEN, NICOLE D (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 STAGECOACH TRL
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-7089
Mailing Address - Country:US
Mailing Address - Phone:845-239-6638
Mailing Address - Fax:
Practice Address - Street 1:29 STAGECOACH TRL
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-7089
Practice Address - Country:US
Practice Address - Phone:845-239-6638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY770845163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics