MEDICARE: NICOLE CATHERINE FLATLEY 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	163W00000X	Registered Nurse	774994	NY

General Provider Information

NPI Number	:	1881235935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CATHERINE FLATLEY RN

Provider Business Mailing Address
First Line	:	18 SPRINGFIELD RD
Second Line	:
City	:	SOUND BEACH
State	:	NY
Zip	:	11789-2825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	266 LINCOLN AVE
Second Line	:
City	:	SAINT JAMES
State	:	NY
Zip	:	11780-1937
Country	:	US
Telephone Number	:	631-584-6270
Fax Number	:

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

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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