Provider Demographics
NPI:1427456771
Name:ROSE, NICOLONIE (LPN)
Entity type:Individual
Prefix:
First Name:NICOLONIE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:NICOLONIE
Other - Middle Name:
Other - Last Name:ROSEDINAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:14538 FRANKTON ST
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3338
Mailing Address - Country:US
Mailing Address - Phone:347-463-1634
Mailing Address - Fax:
Practice Address - Street 1:14538 FRANKTON ST
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3338
Practice Address - Country:US
Practice Address - Phone:347-463-1634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313125-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse