Individual
MS. CORALYN ANTONETTE NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
16937 144TH RD, JAMAICA, NY 11434-5929
(718) 978-7221
Mailing address
10211 186TH ST, HOLLIS, NY 11423-3107
(646) 387-6840
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
298893
NY
Other
Enumeration date
02/15/2010
Last updated
02/15/2010
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