Healthcare Provider Details

I. General information

NPI: 1255379103
Provider Name (Legal Business Name): KARI CRETELLA NICKOU RN, MSN,CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARI CRETELLA NICKOU

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PLEASANT ST
NEWBURYPORT MA
01950-2619
US

IV. Provider business mailing address

25 BOSTON RD
NEWBURY MA
01951-1602
US

V. Phone/Fax

Practice location:
  • Phone: 508-843-1801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN169922
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: