Provider Demographics
NPI:1922838440
Name:RIEHM, NICHOLE MICHELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MICHELLE
Last Name:RIEHM
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 1:1498 DOVER ST
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1020
Mailing Address - Country:US
Mailing Address - Phone:914-330-2412
Mailing Address - Fax:
Practice Address - Street 1:2507 SOUTH RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5458
Practice Address - Country:US
Practice Address - Phone:845-471-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353891-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily