Individual ProviderNicole BryanLicensed Practical NurseNursing Service ProvidersPractice Address55 Glenmalure St, Amityville, NY 11701-1435(631) 671-6358PECOS EnrollmentBased on the most recent information from CMS, provider Nicole Bryan does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1659799005Provider TypeIndividualFull NameBryan, NicoleGenderFemaleSole ProprietorYesEnumeration Date4/2/2014Last Updated4/2/2014Contact InformationPractice LocationPractice Address55 Glenmalure St, Amityville, NY 11701-1435Phone(631) 671-6358FaxUnlisted FaxMailing LocationMailing Address55 Glenmalure St, Amityville, NY 11701-1435PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense312913New York