Provider Demographics
NPI:1699440719
Name:JAMES-DOUGLAS, ELICA KIMLYN
Entity type:Individual
Prefix:
First Name:ELICA
Middle Name:KIMLYN
Last Name:JAMES-DOUGLAS
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 1:41 E 29TH ST APT D3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5076
Mailing Address - Country:US
Mailing Address - Phone:929-330-1461
Mailing Address - Fax:
Practice Address - Street 1:1312 CATON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1099
Practice Address - Country:US
Practice Address - Phone:718-693-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY791627163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse