Individual
MS. NICOLE ALEXANDRA MENEZES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
130 CONDOR ST, EAST BOSTON, MA 02128-1305
(617) 912-7601
Mailing address
23 LANCASTER AVE, REVERE, MA 02151-1732
(781) 215-3217
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XXH982329970
BLUE CHOICE
MA
Enumeration date
08/22/2011
Last updated
08/22/2011
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