Provider Demographics
NPI:1457806580
Name:CROTEAU, NICOLE ANDREE (NNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANDREE
Last Name:CROTEAU
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2401
Mailing Address - Country:US
Mailing Address - Phone:401-274-1122
Mailing Address - Fax:401-453-7571
Practice Address - Street 1:101 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2401
Practice Address - Country:US
Practice Address - Phone:401-274-1122
Practice Address - Fax:401-453-7571
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01437363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care