Provider Demographics
NPI:1861091043
Name:MARCHAND, NICOLE MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:MARCHAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 HAYNES HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01010-9750
Mailing Address - Country:US
Mailing Address - Phone:774-230-8504
Mailing Address - Fax:
Practice Address - Street 1:88 MASONIC HOME RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-1394
Practice Address - Country:US
Practice Address - Phone:508-434-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2267629363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner