Provider Demographics
NPI:1295279966
Name:KOLLMER, NICOLLE C
Entity type:Individual
Prefix:
First Name:NICOLLE
Middle Name:C
Last Name:KOLLMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2327
Mailing Address - Country:US
Mailing Address - Phone:631-790-2910
Mailing Address - Fax:
Practice Address - Street 1:44 JERSEY ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2327
Practice Address - Country:US
Practice Address - Phone:631-790-2910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY724424163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse