Individual
DENISE NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
111 E 210TH ST, BRONX, NY 10467-2401
(718) 920-4702
Mailing address
128 W CLARKSTOWN RD, NEW CITY, NY 10956-1558
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F341494-1
NY
Other
Enumeration date
06/05/2017
Last updated
06/05/2017
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