Provider Demographics
NPI:1801003595
Name:REMBISZ, NICOLE S (APRN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:S
Last Name:REMBISZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:S
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 SHATTUCK WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8007
Mailing Address - Country:US
Mailing Address - Phone:603-431-6677
Mailing Address - Fax:
Practice Address - Street 1:100 SHATTUCK WAY STE 100
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-8007
Practice Address - Country:US
Practice Address - Phone:603-431-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP101062363LP2300X
NH057698-23363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075387Medicaid
ME1801003595Medicaid
NHP00663897OtherMEDICARE RR
NHP00663897OtherMEDICARE RR