Provider Demographics
NPI:1619227667
Name:ANIM, NICOLE (CPNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ANIM
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SHUNAMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:725 CONCORD AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1055
Mailing Address - Country:US
Mailing Address - Phone:617-503-1000
Mailing Address - Fax:617-547-0184
Practice Address - Street 1:725 CONCORD AVE STE 1200
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1055
Practice Address - Country:US
Practice Address - Phone:617-503-1000
Practice Address - Fax:617-547-0184
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382294363LP0200X
MA2311801363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics