Individual
COURTNEY NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1723 N OCEAN AVE, MEDFORD, NY 11763-2687
(631) 758-5858
Mailing address
1723 N OCEAN AVE, MEDFORD, NY 11763-2687
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
307763
NY
Other
Enumeration date
07/02/2016
Last updated
07/02/2016
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