Provider Demographics
NPI:1265583439
Name:YULICO, HEIDI MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:MARIE
Last Name:YULICO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:172 E 91ST ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2447
Mailing Address - Country:US
Mailing Address - Phone:212-828-4890
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:MEMORIAL SLOAN KETTERING CANCER CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-8892
Practice Address - Fax:212-717-3568
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF304543363LA2200X
NYF340634363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health