Individual
NICOLE RAY TYCHOSTUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
107 4TH ST, WATERFORD, NY 12188-2025
(228) 297-6071
Mailing address
107 4TH ST, WATERFORD, NY 12188-2025
(228) 297-6071
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
700535
NY
163WP1700X
Perinatal Registered Nurse
Primary
700535
NY
Other
Enumeration date
03/19/2024
Last updated
03/19/2024
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