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General NPI Number Information
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NPI Number | 1295833598
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Entity Type | Individual
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Provider Name | NICOLE A ROUHANA FNP
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 4417 VESTAL PKWY E BREAST CENTER
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City | VESTAL
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State | NY
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Zip | 13850-3556
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Country | US
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Telephone | 607-240-2885
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Fax | 607-240-2886
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Provider Business Mailing Address
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Address Line | 346 GRAND AVE
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City | JOHNSON CITY
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State | NY
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Zip | 13790-2558
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Country | US
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Telephone | 607-240-2885
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Fax | 607-240-2886
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 000176
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 333072
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License Number State | NY
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