Provider Demographics
NPI:1174950141
Name:STAMM, NICOLE (NP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:STAMM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4720
Mailing Address - Country:US
Mailing Address - Phone:316-987-5963
Mailing Address - Fax:
Practice Address - Street 1:3433 HAROLD ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-4720
Practice Address - Country:US
Practice Address - Phone:631-987-5963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430740-01363LA2100X
NYF430740-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care