MEDICARE: MS. NADEGE POLYNICE LIC PRACTICAL NURSE

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	164W00000X	Licensed Practical Nurse	2677231	NY

General Provider Information

NPI Number	:	1629258660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NADEGE POLYNICE LIC PRACTICAL NURSE

Provider Business Mailing Address
First Line	:	1293 EAST 73RD STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	347-731-2593
Fax Number	:

Provider Business Practice Location Address
First Line	:	1022 EAST 21 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210
Country	:	US
Telephone Number	:	718-692-2079
Fax Number	:

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

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	11/07/2007

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