Provider Demographics
NPI:1891194908
Name:SMITH, NICOLE N (APRN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HITCHCOCK WAY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-7567
Mailing Address - Country:US
Mailing Address - Phone:603-695-2640
Mailing Address - Fax:512-901-3945
Practice Address - Street 1:100 HITCHCOCK WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-7567
Practice Address - Country:US
Practice Address - Phone:603-695-2640
Practice Address - Fax:512-901-3945
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141675363LF0000X
NH063589-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily