Provider Demographics
NPI:1306453931
Name:VICE, SAKINAH M
Entity type:Individual
Prefix:
First Name:SAKINAH
Middle Name:M
Last Name:VICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 N GROVE ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-4469
Mailing Address - Country:US
Mailing Address - Phone:973-337-3329
Mailing Address - Fax:
Practice Address - Street 1:167 N GROVE ST APT 4B
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-4469
Practice Address - Country:US
Practice Address - Phone:973-337-3329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06618000164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse