Provider Demographics
NPI:1548312721
Name:NICHOLS, MARY LOUISE B (C-FNP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LOUISE B
Last Name:NICHOLS
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Gender:F
Credentials:C-FNP
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Mailing Address - Street 1:176 PRESIDENTS LN
Mailing Address - Street 2:302
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1968
Mailing Address - Country:US
Mailing Address - Phone:617-471-8898
Mailing Address - Fax:617-726-4489
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:JACKSON GREY 121
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-8241
Practice Address - Fax:617-726-4489
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA103021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP24576Medicare UPIN
MAE5095ZMedicare ID - Type Unspecified