Provider Demographics
NPI:1548859622
Name:WHALEN, NICOLE MARIE (LPN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:WHALEN
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 1:99 COOK ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1730
Mailing Address - Country:US
Mailing Address - Phone:774-226-0362
Mailing Address - Fax:
Practice Address - Street 1:99 COOK ST
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1730
Practice Address - Country:US
Practice Address - Phone:774-226-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN69268164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse