Provider Demographics
NPI:1588973127
Name:NICOSE, MARY JANE ALCANTARA (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:ALCANTARA
Last Name:NICOSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MARY JANE
Other - Middle Name:RONQUILLO
Other - Last Name:ALCANTARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:777 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3409
Mailing Address - Country:US
Mailing Address - Phone:718-266-6005
Mailing Address - Fax:718-266-6019
Practice Address - Street 1:777 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3409
Practice Address - Country:US
Practice Address - Phone:718-266-6005
Practice Address - Fax:718-266-6019
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY440803-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY440803-1OtherRN LICENSE