MEDICARE: NICOLE BORDEAUX RN

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
1	163W00000X	Registered Nurse	534829-1	NY

General Provider Information

NPI Number	:	1174988315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE BORDEAUX RN

Provider Business Mailing Address
First Line	:	6795 STATE ROUTE 21
Second Line	:
City	:	ALMOND
State	:	NY
Zip	:	14804-9716
Country	:	US
Telephone Number	:	607-276-6535
Fax Number	:

Provider Business Practice Location Address
First Line	:	6795 STATE ROUTE 21
Second Line	:
City	:	ALMOND
State	:	NY
Zip	:	14804-9716
Country	:	US
Telephone Number	:	607-276-6535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	12/15/2015

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Directions to “ NICOLE BORDEAUX RN” Practice Location

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