Healthcare Provider Details

I. General information

NPI: 1831601178
Provider Name (Legal Business Name): NI'COLE WHALEN MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 HARTFORD AVE UNIT BOX 4
JOHNSTON RI
02919-3200
US

IV. Provider business mailing address

251 WATERMAN ST
PROVIDENCE RI
02906-5210
US

V. Phone/Fax

Practice location:
  • Phone: 401-237-0131
  • Fax:
Mailing address:
  • Phone: 401-453-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number02374
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number202062
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: