Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F402720-01 | NY |
NPI | 1033373089 |
---|---|
Provider Name | Mrs. Nicole Margaret Fiacco |
First Address | Albany, NY 12207-1300 |
Second Address | Albany, NY 12207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 22/08/2019 |