Provider Demographics
NPI:1952750770
Name:NURSE NICOLE RN IBCLC
Entity Type:Organization
Organization Name:NURSE NICOLE RN IBCLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, IBCLC
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:F
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, IBCLC
Authorized Official - Phone:617-240-0032
Mailing Address - Street 1:1 VINCENT LN
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2653
Mailing Address - Country:US
Mailing Address - Phone:617-240-0032
Mailing Address - Fax:
Practice Address - Street 1:1 VINCENT LN
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2653
Practice Address - Country:US
Practice Address - Phone:617-240-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care