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General NPI Number Information
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NPI Number | 1912378159
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Entity Type | Individual
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Provider Name | NICOLE HAVILAND CRONIN NP
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Gender | Female
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 75 SYLVAN ST STE B102
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City | DANVERS
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State | MA
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Zip | 01923-2764
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Country | US
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Telephone | 978-880-2872
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Fax |
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Provider Business Mailing Address
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Address Line | 32 MARION RD
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City | MARBLEHEAD
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State | MA
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Zip | 01945-1706
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Country | US
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Telephone | 617-281-5359
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2298800
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN2298800
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License Number State | MA
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