Provider Demographics
NPI:1689000283
Name:NICOLETTA, RENEE C (RN)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:C
Last Name:NICOLETTA
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 1:3945 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:NY
Mailing Address - Zip Code:14568-9580
Mailing Address - Country:US
Mailing Address - Phone:585-313-3431
Mailing Address - Fax:
Practice Address - Street 1:3111 WINTON RD S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2905
Practice Address - Country:US
Practice Address - Phone:585-214-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY417015-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse