Provider Demographics
NPI:1033580915
Name:PADRON, NICHOLE
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:PADRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N 3RD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-1869
Mailing Address - Country:US
Mailing Address - Phone:484-503-8010
Mailing Address - Fax:
Practice Address - Street 1:100 N 3RD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-1869
Practice Address - Country:US
Practice Address - Phone:484-503-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015468363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily