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NPI Code Detail

MEDICARE: LAKEISHA N NICHOLLS NP

MEDICARE: LAKEISHA N NICHOLLS NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerF381608NY
2363LF0000XFamily Nurse Practitioner26NJ01194600NJ
3363LF0000XFamily Nurse PractitionerF347444NY

General Provider Information

NPI Number : 1154407096
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAKEISHA N NICHOLLS NP
Provider Business Mailing Address
First Line : 700 BROADWAY STE 136
Second Line :
City : WESTWOOD
State : NJ
Zip : 07675-1674
Country : US
Telephone Number : 551-265-4342
Fax Number :
Provider Business Practice Location Address
First Line : 255 E HOUSTON ST
Second Line :
City : NEW YORK
State : NY
Zip : 10002-1013
Country : US
Telephone Number : 212-477-1120
Fax Number : 212-477-8957
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2006
Last Update Date : 03/27/2024

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Directions to “ LAKEISHA N NICHOLLS NP” Practice Location

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