Individual
NICELEE FALL HOLLENBACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NPP
Contact information
Practice address
950 DANBY RD STE 202A, ITHACA, NY 14850-5714
(607) 342-5728
(607) 238-4687
Mailing address
28 GOODBAND RD, FREEVILLE, NY 13068-9651
(607) 342-5728
(607) 238-4687
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401500
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
401500
NPP
NY
01
—
5344741
NY STATE RNP LICENSE
NY
Enumeration date
10/25/2011
Last updated
09/21/2023
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