Provider Demographics
NPI:1457146359
Name:KRAUSE, NICHOLAS ERIC (PMHNP)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ERIC
Last Name:KRAUSE
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BAYLEY ST APT 502
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-2986
Mailing Address - Country:US
Mailing Address - Phone:413-219-0006
Mailing Address - Fax:
Practice Address - Street 1:28 BAYLEY ST APT 502
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-2986
Practice Address - Country:US
Practice Address - Phone:413-219-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2302866363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health