Active NPI
Diane Nickerson, LPN
- Licensed Practical Nurse
- Patchogue, NY
National Provider Identifier
1780831263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 238095
- Practice address
- 2 Mainsail Dr
Patchogue, NY 11772-3409 - Phone
- (631) 569-5135
- NPI assigned
- Aug 26, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 238095 | NY | Primary |
Addresses
Primary practice location
2 Mainsail Dr
Patchogue, NY 11772-3409
Mailing address
2 Mainsail Dr
Patchogue, NY 11772-3409
Phone (631) 569-5135
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219708800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219708800000",
"number": "1780831263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 MAINSAIL DR",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117723409",
"telephone_number": "631-569-5135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 MAINSAIL DR",
"city": "PATCHOGUE",
"state": "NY",
"postal_code": "117723409",
"telephone_number": "631-569-5135"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKERSON",
"first_name": "DIANE",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-08-26",
"last_updated": "2008-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "NY",
"license": "238095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Patchogue, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.