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General NPI Number Information
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NPI Number | 1710223516
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Entity Type | Individual
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Provider Name | NICOLE LACY RN
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Gender | Female
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Dates
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Enumeration Date | 12/26/2012
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Last Update Date | 03/09/2024
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Provider Practice Location Address
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Address Line | 14426 120TH AVE
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City | JAMAICA
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State | NY
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Zip | 11436-1503
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Country | US
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Telephone | 718-506-8057
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Fax |
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Provider Business Mailing Address
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Address Line | 14426 120TH AVE
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City | JAMAICA
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State | NY
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Zip | 11436-1503
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Country | US
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Telephone | 718-506-8057
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 343280950612E
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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 | 806780
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License Number State | NY
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