Provider Demographics
NPI:1932342623
Name:NICOLAS, FARAH (RN)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:NICOLAS
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 1:1352 HIGBIE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2027
Mailing Address - Country:US
Mailing Address - Phone:516-593-9522
Mailing Address - Fax:
Practice Address - Street 1:1352 HIGBIE ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2027
Practice Address - Country:US
Practice Address - Phone:516-593-9522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-12
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY584682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse