Healthcare Provider Details

I. General information

NPI: 1912378159
Provider Name (Legal Business Name): NICOLE HAVILAND CRONIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE HAVILAND WILLIAMS RN

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SYLVAN ST STE B102
DANVERS MA
01923-2764
US

IV. Provider business mailing address

32 MARION RD
MARBLEHEAD MA
01945-1706
US

V. Phone/Fax

Practice location:
  • Phone: 978-880-2872
  • Fax:
Mailing address:
  • Phone: 617-281-5359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2298800
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN2298800
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: