Provider Demographics
NPI:1982937108
Name:NICOLAIS, LYNN C (RN)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:C
Last Name:NICOLAIS
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 1:42 FENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-3912
Mailing Address - Country:US
Mailing Address - Phone:845-621-1654
Mailing Address - Fax:
Practice Address - Street 1:42 FENWOOD RD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-3912
Practice Address - Country:US
Practice Address - Phone:845-621-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296649-1163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice