Healthcare Provider Details

I. General information

NPI: 1598861825
Provider Name (Legal Business Name): NICA CHERY-MOMPREMIER CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87-41 PARSONS BLVD ROOM 102 SCHOOL BOARD HEALTH CLINIC P.S86
JAMAICA NY
11432
US

IV. Provider business mailing address

82-68 164TH STREET PAVILION ROOM 113 QUEENS HOSPITAL CENTER
QUEENS NY
11432
US

V. Phone/Fax

Practice location:
  • Phone: 718-526-3589
  • Fax: 718-297-0298
Mailing address:
  • Phone: 718-883-4500
  • Fax: 718-883-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberF380927
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: