Healthcare Provider Details

I. General information

NPI: 1386993160
Provider Name (Legal Business Name): NICOLE VILAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 163RD ST
JAMAICA NY
11432-4046
US

IV. Provider business mailing address

12142 238TH ST
ROSEDALE NY
11422-1044
US

V. Phone/Fax

Practice location:
  • Phone: 718-739-0045
  • Fax:
Mailing address:
  • Phone: 718-525-4513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number564942
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: