Provider Demographics
NPI:1487279774
Name:DAVEY, NICCOLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:NICCOLE
Middle Name:
Last Name:DAVEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CNY FERTILITY
Mailing Address - Street 2:38A OLD SPARROWBUSH RD
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110
Mailing Address - Country:US
Mailing Address - Phone:518-724-5710
Mailing Address - Fax:518-724-5757
Practice Address - Street 1:38A OLD SPARROWBUSH RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2927
Practice Address - Country:US
Practice Address - Phone:518-690-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily