Healthcare Provider Details

I. General information

NPI: 1952042889
Provider Name (Legal Business Name): NICOLE GELIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: N/A N/A REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 RIVER ST STE 2
WALTHAM MA
02453-5483
US

IV. Provider business mailing address

431 RIVER ST STE 2
WALTHAM MA
02453-5483
US

V. Phone/Fax

Practice location:
  • Phone: 781-966-5679
  • Fax:
Mailing address:
  • Phone: 781-966-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN10002583
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN2262602
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: