Healthcare Provider Details

I. General information

NPI: 1922329291
Provider Name (Legal Business Name): KAYON NICOLA NASH REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 E 91ST ST
BROOKLYN NY
11236-4906
US

IV. Provider business mailing address

1482 E 91ST ST
BROOKLYN NY
11236-4906
US

V. Phone/Fax

Practice location:
  • Phone: 646-912-1858
  • Fax:
Mailing address:
  • Phone: 646-912-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number611141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: