Brandi Poenicke
Individual provider Active NPI Registered Nurse · 8459012986, NY
NPI 1497559686 · NPPES record last updated Apr 4, 2025
Key facts
- NPI
- 1497559686
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 645180 (NY)
- Practice address
- M. Clifford Miller Middle School
65 Fording Place Road
8459012986, NY 12449 - Phone
- (845) 901-2986
- NPI assigned
- Apr 4, 2025
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 645180 | NY | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 645180 | NY | Yes |
Addresses
Primary practice location
M. Clifford Miller Middle School
65 Fording Place Road
8459012986, NY 12449
Mailing address
M. Clifford Miller Middle School
65 Fording Place Road
8459012986, NY 12449
Phone (845) 901-2986
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.