Provider Demographics
NPI:1750186052
Name:BRADY, NICOLE JENSEN (NNP-BC, RN-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JENSEN
Last Name:BRADY
Suffix:
Gender:
Credentials:NNP-BC, RN-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:JENSEN
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3823 CARY GLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-1872
Mailing Address - Country:US
Mailing Address - Phone:919-244-0877
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4699
Practice Address - Country:US
Practice Address - Phone:919-684-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021699363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal