Healthcare Provider Details

I. General information

NPI: 1407689482
Provider Name (Legal Business Name): NICOLE HAAS-LOOMIS RN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HERRICK ST STE 3002
BEVERLY MA
01915-2757
US

IV. Provider business mailing address

83 HERRICK ST STE 3002
BEVERLY MA
01915-2757
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-4800
  • Fax:
Mailing address:
  • Phone: 978-927-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2184444
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10037771
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: