Provider Demographics
NPI:1003453820
Name:SPRING, NICOLE AUDRA (BSBA)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:AUDRA
Last Name:SPRING
Suffix:
Gender:F
Credentials:BSBA
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:AUDRA
Other - Last Name:SPRING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSBA
Mailing Address - Street 1:181 NH ROUTE 106
Mailing Address - Street 2:
Mailing Address - City:GILMANTON
Mailing Address - State:NH
Mailing Address - Zip Code:03237-4925
Mailing Address - Country:US
Mailing Address - Phone:603-581-6592
Mailing Address - Fax:
Practice Address - Street 1:218 GILMANTON RD
Practice Address - Street 2:
Practice Address - City:BARNSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03218-3183
Practice Address - Country:US
Practice Address - Phone:603-409-1091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-01
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1003453820Medicaid