Healthcare Provider Details

I. General information

NPI: 1447748611
Provider Name (Legal Business Name): KYMBERLI NYKOLE REGINELLA LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 OAKDALE RD
EAST MEADOW NY
11554-5206
US

IV. Provider business mailing address

566 OAKDALE RD
EAST MEADOW NY
11554-5206
US

V. Phone/Fax

Practice location:
  • Phone: 516-640-7430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number329160-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number329160-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: