Individual
NICHOLE M MAILLOUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-3452
(508) 334-7284
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN216625
MA
363LA2100X
Acute Care Nurse Practitioner
003481
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004034815
—
CT
05
—
Q76688
—
CT
Enumeration date
02/09/2007
Last updated
11/04/2020
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