MEDICARE: NICOLE CUMMINGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1205636396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE CUMMINGS

Provider Business Mailing Address
First Line	:	1 MAPLE SPRING DR
Second Line	:
City	:	RUTLAND
State	:	MA
Zip	:	01543-1223
Country	:	US
Telephone Number	:	508-826-5795
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MAPLE SPRING DR
Second Line	:
City	:	RUTLAND
State	:	MA
Zip	:	01543-1223
Country	:	US
Telephone Number	:	508-826-5795
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2025
Last Update Date	:	03/17/2025

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Directions to “ NICOLE CUMMINGS ” Practice Location

Language	Start Address	Practice Location

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