Healthcare Provider Details

I. General information

NPI: 1902731474
Provider Name (Legal Business Name): ANNETTE NICHOLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL
BOSTON MA
02118-2908
US

IV. Provider business mailing address

161 SAVANNAH AVE
BOSTON MA
02126-1346
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-4038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRT10433
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: