Healthcare Provider Details

I. General information

NPI: 1962086553
Provider Name (Legal Business Name): NICOLE LYNN DENUCCIO RN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 2ND AVE
BROOKLYN NY
11220-3599
US

IV. Provider business mailing address

5610 2ND AVE
BROOKLYN NY
11220-3599
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-7241
  • Fax:
Mailing address:
  • Phone: 718-630-7241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number722749
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number002082
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: