Individual
SAMUEL R MICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
175 REMSEN ST FL 10, BROOKLYN, NY 11201-4300
(718) 852-5552
Mailing address
175 REMSEN ST FL 10, BROOKLYN, NY 11201-4300
(718) 852-5552
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
569459-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
569459-1
RN
NY
Enumeration date
01/27/2010
Last updated
01/27/2010
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