Provider Demographics
NPI:1386213643
Name:CARDELLE, NICOLE EMILY
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:EMILY
Last Name:CARDELLE
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 1:20 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2209
Mailing Address - Country:US
Mailing Address - Phone:978-677-6087
Mailing Address - Fax:978-677-6129
Practice Address - Street 1:12 GERSHOM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2802
Practice Address - Country:US
Practice Address - Phone:978-770-5173
Practice Address - Fax:978-677-6129
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist