Healthcare Provider Details

I. General information

NPI: 1194200139
Provider Name (Legal Business Name): NICOLE ELIZABETH MANSEAU CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2018
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ADMINISTRATION RD
BRIDGEWATER MA
02324-3201
US

IV. Provider business mailing address

20 ADMINISTRATION RD
BRIDGEWATER MA
02324-3201
US

V. Phone/Fax

Practice location:
  • Phone: 508-279-4500
  • Fax:
Mailing address:
  • Phone: 508-279-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2312233
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2312233
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: