Individual
BEVERLY NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12510 QUEENS BLVD, KEW GARDENS, NY 11415-1519
(718) 459-5592
(718) 459-6047
Mailing address
12510 QUEENS BLVD, KEW GARDENS, NY 11415-1519
(718) 459-5592
(718) 459-6047
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
9569L001
NY
364SH0200X
Home Health Clinical Nurse Specialist
9569L001
NY
374U00000X
Home Health Aide
9569L001
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01761260
—
NY
Enumeration date
11/14/2006
Last updated
12/13/2021
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