Healthcare Provider Details

I. General information

NPI: 1821855834
Provider Name (Legal Business Name): BREEANNA A NICOLETTI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BREE-ANNA A NICOLETTI APRN

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 09/02/2024
Certification Date: 09/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BEACON ST STE 6A
BROOKLINE MA
02446-3806
US

IV. Provider business mailing address

15 DOBLE AVE APT B
MEDFORD MA
02155-6121
US

V. Phone/Fax

Practice location:
  • Phone: 866-542-2865
  • Fax:
Mailing address:
  • Phone: 781-640-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2372112
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: