Healthcare Provider Details

I. General information

NPI: 1699536961
Provider Name (Legal Business Name): NICHOLAS STANLEY NIKEL RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E AND WEST RD
WEST SENECA NY
14224-3602
US

IV. Provider business mailing address

1010 E AND WEST RD
WEST SENECA NY
14224-3602
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-7117
  • Fax:
Mailing address:
  • Phone: 716-677-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number339765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: