MEDICARE: ROSELE NICOLAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	338721	NY

General Provider Information

NPI Number	:	1215337894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSELE NICOLAS

Provider Business Mailing Address
First Line	:	2150 HENDRICKSON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5041
Country	:	US
Telephone Number	:	718-508-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 HENDRICKSON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5041
Country	:	US
Telephone Number	:	718-508-2047
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2014
Last Update Date	:	05/07/2019

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Directions to “ ROSELE NICOLAS ” Practice Location

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