Healthcare Provider Details

I. General information

NPI: 1730352881
Provider Name (Legal Business Name): DENISE ELLYN CICONE R.N., B.S., LNC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 ALLISON AVE
TAUNTON MA
02780-6958
US

IV. Provider business mailing address

68 ALLISON AVE
TAUNTON MA
02780-6958
US

V. Phone/Fax

Practice location:
  • Phone: 508-880-0202
  • Fax: 508-880-2425
Mailing address:
  • Phone: 508-880-0202
  • Fax: 508-880-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number213999
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: