Provider Demographics
NPI:1568198638
Name:SMITH, NICOLE ANN (RN, MS, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN, MS, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 DARTMOUTH ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6009
Mailing Address - Country:US
Mailing Address - Phone:607-437-2774
Mailing Address - Fax:
Practice Address - Street 1:83 HERRICK ST STE 2004
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2757
Practice Address - Country:US
Practice Address - Phone:607-437-2774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2347225363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health