Most Relevant Information
Provider Data
| NPI Number: | 1003696600 |
| Provider Name: | DINA NICKLAS |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | 405355 |
Most Important Dates
| Enumeration Date: | 10/02/2023 |
| Last Updated: | 10/02/2023 |
Provider Practice Location
84 WRIGHT AVE
DEER PARK
NY
117292808
Practice Location Phone/Fax
| Phone: | 6312415928 |
| Fax: |
Provider Mailing Location
84 WRIGHT AVE
DEER PARK
NY
117292808
Provider Mailing Phone/Fax
| Phone: | 6312415928 |
| Fax: |