Provider Demographics
NPI:1639113277
Name:MAY, NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PHILIPS RD
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-4425
Mailing Address - Country:US
Mailing Address - Phone:781-507-3101
Mailing Address - Fax:
Practice Address - Street 1:207 STAGE RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-2224
Practice Address - Country:US
Practice Address - Phone:603-329-5222
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0452363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30332314Medicaid
NH30332314Medicaid