Provider Demographics
NPI:1902331150
Name:PHOENIX, NIKISHA RENESHA (RN)
Entity Type:Individual
Prefix:
First Name:NIKISHA
Middle Name:RENESHA
Last Name:PHOENIX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 50TH ST
Mailing Address - Street 2:2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1449
Mailing Address - Country:US
Mailing Address - Phone:718-431-8988
Mailing Address - Fax:718-431-8598
Practice Address - Street 1:1279 50TH ST
Practice Address - Street 2:2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1449
Practice Address - Country:US
Practice Address - Phone:718-431-8988
Practice Address - Fax:718-431-8598
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY726229163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY726229OtherNYS NURSING LICENSE