Provider Demographics
NPI:1912378159
Name:CRONIN, NICOLE HAVILAND (NP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:HAVILAND
Last Name:CRONIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:HAVILAND
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:32 MARION RD
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-1706
Mailing Address - Country:US
Mailing Address - Phone:617-281-5359
Mailing Address - Fax:
Practice Address - Street 1:75 SYLVAN ST STE B102
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2764
Practice Address - Country:US
Practice Address - Phone:978-880-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-14
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2298800163W00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse