Healthcare Provider Details

I. General information

NPI: 1992154397
Provider Name (Legal Business Name): NICOLE MARIE PASSINI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E POST RD
WHITE PLAINS NY
10601-4699
US

IV. Provider business mailing address

9 AUSTIN PL
BRIARCLIFF MANOR NY
10510-2641
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-0600
  • Fax:
Mailing address:
  • Phone: 573-450-9562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number767242
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN655217
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: