Healthcare Provider Details

I. General information

NPI: 1154374981
Provider Name (Legal Business Name): MARIE NIKOLOFF RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BUTTERFIELD RD
KINGSTON RI
02881-1116
US

IV. Provider business mailing address

321 S COUNTY TRL
EXETER RI
02822-3527
US

V. Phone/Fax

Practice location:
  • Phone: 401-874-4991
  • Fax: 401-874-9110
Mailing address:
  • Phone: 401-295-8616
  • Fax: 401-295-0983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP24378
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: