Provider Demographics
NPI:1881143675
Name:LEATHERSICH, NICOLE LOUISE (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LOUISE
Last Name:LEATHERSICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LOUISE
Other - Last Name:SWITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:66 BIG RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1221
Mailing Address - Country:US
Mailing Address - Phone:585-775-7365
Mailing Address - Fax:
Practice Address - Street 1:66 BIG RIDGE RD
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1221
Practice Address - Country:US
Practice Address - Phone:585-775-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22645138163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool