Individual ProviderDiane NickersonLicensed Practical NurseNursing Service ProvidersPractice Address2 Mainsail Dr, Patchogue, NY 11772-3409(631) 569-5135PECOS EnrollmentBased on the most recent information from CMS, provider Diane Nickerson 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 2 days ago.Profile DetailsProvider ID1780831263Provider TypeIndividualFull NameNickerson, DianeCredentialLPNGenderFemaleSole ProprietorYesEnumeration Date8/26/2008Last Updated8/26/2008Contact InformationPractice LocationPractice Address2 Mainsail Dr, Patchogue, NY 11772-3409Phone(631) 569-5135FaxUnlisted FaxMailing LocationMailing Address2 Mainsail Dr, Patchogue, NY 11772-3409Phone(631) 569-5135FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense238095New York