Provider Demographics
NPI:1104276757
Name:POITRAS, NICOLE CORRINE (MSN, APRN)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:CORRINE
Last Name:POITRAS
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 LITCHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-2624
Mailing Address - Country:US
Mailing Address - Phone:603-845-7718
Mailing Address - Fax:
Practice Address - Street 1:89 S MAST ST
Practice Address - Street 2:#6
Practice Address - City:GOFFSTOWN
Practice Address - State:NH
Practice Address - Zip Code:03045-6102
Practice Address - Country:US
Practice Address - Phone:603-497-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH046532-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily