Provider Demographics
NPI:1982962460
Name:KICH, DAINELLE (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:DAINELLE
Middle Name:
Last Name:KICH
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:DR
Other - First Name:DAINELLE
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:208 TOWNSHIP BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1786
Mailing Address - Country:US
Mailing Address - Phone:315-551-6000
Mailing Address - Fax:
Practice Address - Street 1:208 TOWNSHIP BLVD
Practice Address - Street 2:
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1786
Practice Address - Country:US
Practice Address - Phone:315-551-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337262363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03543111Medicaid