Healthcare Provider Details

I. General information

NPI: 1124320429
Provider Name (Legal Business Name): NICOLE KATIUSKA ESCALERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 FEDERAL ST APT 2R
SALEM MA
01970-3252
US

IV. Provider business mailing address

92 FEDERAL ST APT 2R
SALEM MA
01970-3252
US

V. Phone/Fax

Practice location:
  • Phone: 781-929-2352
  • Fax:
Mailing address:
  • Phone: 781-929-2352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: