Provider Demographics
NPI:1952917866
Name:DEPRONIO, NIKITA ROSE (AGNP)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:ROSE
Last Name:DEPRONIO
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:NIKITA
Other - Middle Name:ROSE
Other - Last Name:MORALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6934 WILLIAMS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3080
Mailing Address - Country:US
Mailing Address - Phone:716-297-8260
Mailing Address - Fax:716-279-3479
Practice Address - Street 1:6934 WILLIAMS RD STE 200
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3080
Practice Address - Country:US
Practice Address - Phone:716-297-8260
Practice Address - Fax:716-297-1360
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309737363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health