Nicole Innace

NPI #1578974630 in Holbrook, New York

Provider Information

NPI Number: 1578974630
Entity Type: Individual
Name: Nicole Innace
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Enumeration Date: May 12, 2014
Last Updated: Apr 10, 2015

Practice Location

Address: 45 TIMBER RIDGE DR
City: Holbrook
State: New York
ZIP Code: 11741-4142
Phone: (631) 472-8162

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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