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General NPI Number Information
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NPI Number | 1184968430
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Entity Type | Individual
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Provider Name | IRISI NIKOLLA NP
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Gender | Female
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Dates
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Enumeration Date | 11/26/2012
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Last Update Date | 09/05/2023
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Provider Practice Location Address
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Address Line | 129 SENECA ST
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City | STATEN ISLAND
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State | NY
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Zip | 10310-2333
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Country | US
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Telephone | 347-216-7632
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Fax |
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Provider Business Mailing Address
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Address Line | 533 OVINGTON AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-1701
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Country | US
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Telephone | 347-216-7632
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0000000
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 664266
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License Number State | NY
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