Healthcare Provider Details

I. General information

NPI: 1457224230
Provider Name (Legal Business Name): DONTAE FEMALE MCNICHOL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 HERITAGE CIR
TEATICKET MA
02536-5722
US

IV. Provider business mailing address

451 ANDOVER ST STE 205
NORTH ANDOVER MA
01845-5079
US

V. Phone/Fax

Practice location:
  • Phone: 754-715-1006
  • Fax:
Mailing address:
  • Phone: 781-480-7017
  • Fax: 781-819-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2344965
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2344965
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: