Provider Demographics
NPI:1467560540
Name:CHASE, NICOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CHASE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3776
Mailing Address - Country:US
Mailing Address - Phone:207-879-3470
Mailing Address - Fax:207-879-3153
Practice Address - Street 1:111 OSSIPEE TRL E
Practice Address - Street 2:SUITE 1142
Practice Address - City:STANDISH
Practice Address - State:ME
Practice Address - Zip Code:04084-6464
Practice Address - Country:US
Practice Address - Phone:207-642-4434
Practice Address - Fax:207-642-4439
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MENP544201Medicare PIN
Q55021Medicare UPIN