Individual
BRENDA MICKENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
420 VERAZZANO AVE, COPIAGUE, NY 11726-1713
(631) 767-9090
Mailing address
420 VERAZZANO AVE, COPIAGUE, NY 11726-1713
(631) 532-5061
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
655015
NY
164W00000X
Licensed Practical Nurse
225231
NY
Other
Enumeration date
03/30/2010
Last updated
06/11/2012
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