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Individual

NICOLE R HUMISTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
2 NEW HAMPSHIRE AVE, TROY, NY 12180-1764
(518) 272-0331
Mailing address
PO BOX 14890, ALBANY, NY 12212-4890
(518) 525-5634

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
571292
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
309595
NY

Other

Enumeration date
01/17/2020
Last updated
05/06/2021
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