Provider Demographics
NPI:1265420186
Name:DUANE, NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DUANE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, NP
Mailing Address - Street 1:84 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-2226
Mailing Address - Country:US
Mailing Address - Phone:978-793-3498
Mailing Address - Fax:
Practice Address - Street 1:84 SUMMER ST
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-2226
Practice Address - Country:US
Practice Address - Phone:978-793-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193980363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics