Healthcare Provider Details

I. General information

NPI: 1407157795
Provider Name (Legal Business Name): STELLA PATRICIA VILCEUS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

1236 E 104TH ST
BROOKLYN NY
11236-4506
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8000
  • Fax:
Mailing address:
  • Phone: 718-241-1723
  • Fax: 718-241-1723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number355281
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: