Individual
NICOLE MIKULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
275 CHENANGO ST, BINGHAMTON, NY 13901-2312
(607) 201-1204
Mailing address
2570 ROUTE 9W STE 10, CORNWALL, NY 12518-1370
(845) 220-3100
(845) 534-2940
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402704
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
SP020889
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07630615
—
NY
Enumeration date
03/04/2019
Last updated
08/02/2023
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