Provider Demographics
NPI:1982402012
Name:NORMAN, NICHOLE LORRAINE (LPN)
Entity type:Individual
Prefix:MISS
First Name:NICHOLE
Middle Name:LORRAINE
Last Name:NORMAN
Suffix:
Gender:
Credentials:LPN
Other - Prefix:MISS
Other - First Name:NICHOLE
Other - Middle Name:L
Other - Last Name:NORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:488 FENIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-2128
Mailing Address - Country:US
Mailing Address - Phone:516-538-4674
Mailing Address - Fax:
Practice Address - Street 1:380 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1845
Practice Address - Country:US
Practice Address - Phone:516-378-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311410-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse