Individual
AVA GAYLE NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4382 FURMAN AVE APT 3K, BRONX, NY 10466-1509
(646) 314-1448
Mailing address
4382 FURMAN AVE APT 3K, BRONX, NY 10466-1509
(646) 314-1448
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
332164
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
850110618
NEW YORK STATE DRIVERS LICENSE
NY
Enumeration date
08/28/2018
Last updated
07/21/2022
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