Provider Demographics
NPI:1043935620
Name:ARVIDSON, NICOLE SASHANNA (AGNP- BC, MSN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SASHANNA
Last Name:ARVIDSON
Suffix:
Gender:
Credentials:AGNP- BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-1402
Mailing Address - Country:US
Mailing Address - Phone:914-837-1997
Mailing Address - Fax:
Practice Address - Street 1:4 WESTCHESTER PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3431
Practice Address - Country:US
Practice Address - Phone:914-837-1997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310952363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health