Provider Demographics
NPI:1982470720
Name:AMANQUANOR, NICOLE GIFTY (RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:GIFTY
Last Name:AMANQUANOR
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 1:98 LASALLE DR
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-3112
Mailing Address - Country:US
Mailing Address - Phone:646-305-4191
Mailing Address - Fax:
Practice Address - Street 1:98 LASALLE DR
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-3112
Practice Address - Country:US
Practice Address - Phone:646-305-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-599977163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse