Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 01190 | LA |
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP01190 | LA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP01190 | LA |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | RN041131 | LA |
NPI | 1174714588 |
---|---|
Provider Name | Cheryl Lynn Nicks |
First Address | Marrero, LA 70072 |
Second Address | Marrero, LA 70072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 06/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08025373 | (05) | MS |
1134007 | (05) | LA |
P67348 | (02) | LA |