Healthcare Provider Details

I. General information

NPI: 1437528288
Provider Name (Legal Business Name): NICOLE MARIE GRIFFITH CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 KENDRICK ST SUITE 204
NEEDHAM MA
02494-2726
US

IV. Provider business mailing address

20 RESEARCH PKWY
OLD SAYBROOK CT
06475-4214
US

V. Phone/Fax

Practice location:
  • Phone: 800-370-3651
  • Fax: 877-515-7147
Mailing address:
  • Phone: 800-370-3651
  • Fax: 877-515-7147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2267213
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: