Provider Demographics
NPI:1447524590
Name:NEPHEW, NICHOLE DENICE (LPN)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:DENICE
Last Name:NEPHEW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:DENICE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7834 STATE ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:WEST CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12992-3235
Mailing Address - Country:US
Mailing Address - Phone:518-565-7285
Mailing Address - Fax:
Practice Address - Street 1:7285 RT 22
Practice Address - Street 2:
Practice Address - City:WEST CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12992
Practice Address - Country:US
Practice Address - Phone:518-565-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299711164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse