Provider Demographics
NPI:1225578982
Name:CORREALE, NICOLE JANEL (NP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JANEL
Last Name:CORREALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-4605
Mailing Address - Country:US
Mailing Address - Phone:617-751-5500
Mailing Address - Fax:
Practice Address - Street 1:173 FOREST ST
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:MA
Practice Address - Zip Code:01949-1909
Practice Address - Country:US
Practice Address - Phone:781-983-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAG02170143363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health