Provider Demographics
NPI:1982847869
Name:CLAYTON, NICOLE M (LPN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:LPN
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 1232
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1232
Mailing Address - Country:US
Mailing Address - Phone:207-528-2285
Mailing Address - Fax:
Practice Address - Street 1:59 BANGOR ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1740
Practice Address - Country:US
Practice Address - Phone:207-528-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEP010324164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse