Provider Demographics
NPI:1538350632
Name:INCE, CAROL LEONARD (RN,NP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LEONARD
Last Name:INCE
Suffix:
Gender:F
Credentials:RN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 GAIR ST
Mailing Address - Street 2:
Mailing Address - City:PIERMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10968-1080
Mailing Address - Country:US
Mailing Address - Phone:845-365-3055
Mailing Address - Fax:
Practice Address - Street 1:407 GAIR ST
Practice Address - Street 2:
Practice Address - City:PIERMONT
Practice Address - State:NY
Practice Address - Zip Code:10968-1080
Practice Address - Country:US
Practice Address - Phone:845-365-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275954163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02694695Medicaid