Provider Demographics
NPI:1649034505
Name:ROCRAY LACHANCE, NICOLE TINA (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TINA
Last Name:ROCRAY LACHANCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04087-0375
Mailing Address - Country:US
Mailing Address - Phone:207-710-3609
Mailing Address - Fax:
Practice Address - Street 1:2 LEHNER RD
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1836
Practice Address - Country:US
Practice Address - Phone:207-300-2471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN70327163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse