Healthcare Provider Details

I. General information

NPI: 1821562836
Provider Name (Legal Business Name): ERIN BUCKLEY NICHOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1269 MAIN ST
CONCORD MA
01742-3099
US

IV. Provider business mailing address

9 MARTIN ST
ACTON MA
01720-3511
US

V. Phone/Fax

Practice location:
  • Phone: 978-287-7951
  • Fax:
Mailing address:
  • Phone: 978-831-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN2323662
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: