Provider Demographics
NPI:1073032116
Name:PRIMOFF, NICOLE CHRISTINE (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:PRIMOFF
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RALPH ST
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-1842
Mailing Address - Country:US
Mailing Address - Phone:310-359-2008
Mailing Address - Fax:
Practice Address - Street 1:25 RALPH ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-1842
Practice Address - Country:US
Practice Address - Phone:310-359-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421306363LW0102X
NY001801176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health