Healthcare Provider Details

I. General information

NPI: 1154128791
Provider Name (Legal Business Name): NICOLE BLATHRAS RN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 COMMERCIAL ST
WEYMOUTH MA
02189-3082
US

IV. Provider business mailing address

23 MILBERY LN
PEMBROKE MA
02359-1700
US

V. Phone/Fax

Practice location:
  • Phone: 781-340-1124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2353934
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: