MEDICARE: NYCKIYAH JAHNI MULKEY RN

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	163WP0200X	Pediatric Registered Nurse	745452	NY

General Provider Information

NPI Number	:	1861082042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYCKIYAH JAHNI MULKEY RN

Provider Business Mailing Address
First Line	:	530 GILMOUR ST APT 3
Second Line	:
City	:	WEST HENRIETTA
State	:	NY
Zip	:	14586-8826
Country	:	US
Telephone Number	:	718-710-1042
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 GILMOUR ST APT 3
Second Line	:
City	:	WEST HENRIETTA
State	:	NY
Zip	:	14586-8826
Country	:	US
Telephone Number	:	718-710-1042
Fax Number	:

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

Provider Enumeration Date	:	01/21/2021
Last Update Date	:	01/22/2021

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