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General NPI Number Information
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NPI Number | 1700057437
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Entity Type | Individual
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Provider Name | NICKLOS MICHAEL MARKEY APRN
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Gender | Male
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Dates
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Enumeration Date | 03/20/2008
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Last Update Date | 02/19/2011
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Provider Practice Location Address
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Address Line | 263 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06030-0001
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Country | US
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Telephone | 860-679-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 67 GLENWOOD RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3027
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Country | US
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Telephone | 860-648-2620
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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 | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | 003546
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 003546
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License Number State | CT
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