NICOLE WYNNE (NPI# 1164967105) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164967105 |
| Entity Type | Individual |
| Full Name | NICOLE WYNNE |
| Practice Address |
120 Murray St Medford MA 02155-1300 |
| Mailing Address |
92 Litchfield Ln Hanson MA 02341-1011 |
| Practice Telephone | 7813910800 |
| Mailing Telephone | 7817242201 |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2016-12-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | MA | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 390200000X | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316194095 | Nicole Wynne | Dietitian, Registered | 200 Edie Ann Dr, Lafayette, LA 70508-5325 | 2008-08-25 |
| Street Address |
120 MURRAY ST |
| City | MEDFORD |
| State | MA |
| Zip Code | 02155-1300 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306210034 | Amy Maher Feck | Physical Therapist | 120 Murray St, Medford, MA 02155-1300 | 2015-11-18 |
| 1275097651 | Melissa Nicole Pothier | Occupational Therapy Assistant | 120 Murray St, Medford, MA 02155-1300 | 2019-01-30 |
| 1508337858 | Samantha Chmura | Occupational Therapist | 120 Murray St, Medford, MA 02155-1300 | 2018-12-16 |
| 1285126144 | Aaron Michael Lewis | Physical Therapy Assistant | 120 Murray St, Medford, MA 02155-1300 | 2018-06-05 |
| 1215452768 | Ashley Bovarnick | Occupational Therapy Assistant | 120 Murray St, Medford, MA 02155-1300 | 2017-08-06 |
| 1164950994 | John Charles Chambers | Occupational Therapist | 120 Murray St, Medford, MA 02155-1300 | 2017-05-24 |
| 1841724630 | Christopher Lewin | Physical Therapy Assistant | 120 Murray St, Medford, MA 02155-1300 | 2017-04-18 |
| 1164870127 | Victoria Diamond | Student in an Organized Health Care Education/Training Program | 120 Murray St, Medford, MA 02155-1300 | 2016-06-01 |
| 1790145951 | Sarah Noelle Villard | Speech-Language Pathologist | 120 Murray St, Medford, MA 02155-1300 | 2016-03-02 |
| 1558735175 | Kara Owczarek | Occupational Therapist | 120 Murray St, Medford, MA 02155-1300 | 2015-11-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679113922 | Elena Chapman | Nurse Practitioner | 293 Salem St 4, Medford, MA 02155 | 2020-01-14 |
| 1922658830 | Michelle Anne Zona | Counselor | 100 George Hassett Dr, Medford, MA 02155 | 2019-09-13 |
| 1487138509 | Dava Davainis | Social Worker | 76 Newbern Avenue, Apt. 1, Medford, MA 02155 | 2018-09-25 |
| 1265915128 | Erin Roberts | Counselor | Medford Public Schools, 3002 Mystic Valley Pkwy, Medford, MA 02155 | 2018-09-07 |
| 1871075739 | Janice Madeline Cole | Social Worker | 3820 Mystic Valley Pkwy Unit 805, Medford, MA 02155 | 2018-09-06 |
| 1447732573 | Mystick Women's Health, Inc. | Obstetrics & Gynecology | 13 Bradlee Road, Medford, MA 02155 | 2018-09-05 |
| 1144713090 | Laura Rogers | Psychologist | 203 Paige Hall, 12 Upper Campus Road, Medford, MA 02155 | 2018-06-14 |
| 1871086694 | Shuo Yang | Dentist | 8 9th St Apt 310, Medford, MA 02155 | 2018-06-07 |
| 1891287108 | Xuhua Qin | Psychologist | 120 Curtis Street, Medford, MA 02155 | 2018-06-01 |
| 1568953529 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 471 Salem St, Medford, MA 02155 | 2018-05-25 |
| Find all providers in zip 02155 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821696261 | Julia Elizabeth Erskine | Student in an Organized Health Care Education/Training Program | 119 Boston Ave Apt 1, Medford, MA 02155-3570 | 2020-10-16 |
| 1720695695 | Elizabeth Moynihan | Student in an Organized Health Care Education/Training Program | 9 Marion St, Medford, MA 02155-6219 | 2020-09-25 |
| 1043820764 | Shane L Totten | Student in an Organized Health Care Education/Training Program | 19 Hamilton St, Medford, MA 02155-4207 | 2020-08-06 |
| 1649810136 | Kelly Alaina Walsh | Student in an Organized Health Care Education/Training Program | 289 Elm St Apt 62c, Medford, MA 02155-1068 | 2020-01-13 |
| 1487150785 | Sara Krivan | Student in an Organized Health Care Education/Training Program | 205 Jamaica Ave, Medford, NY 11763-3239 | 2018-04-04 |
| 1508316829 | Sierra Ruth Fuller | Student in an Organized Health Care Education/Training Program | 345 Salem St, Medford, MA 02155-3308 | 2016-10-11 |
| 1447605159 | Andrew Allen Fryer | Student in an Organized Health Care Education/Training Program | 32 Nottingham Dr, Medford, NJ 08055-8533 | 2016-05-01 |
| 1376959411 | Parham Shahkar | Student in an Organized Health Care Education/Training Program | 3920 Mystic Valley Pkwy Apt 1121, Medford, MA 02155-6911 | 2014-07-09 |
| 1669895181 | Louise Haddock | Student in an Organized Health Care Education/Training Program | 12 Hadley Pl, #2, Medford, MA 02155-3905 | 2014-02-04 |
| 1275964256 | Steven Matta | Student in an Organized Health Care Education/Training Program | 100 Station Lndg Unit 405, Medford, MA 02155-5179 | 2013-12-02 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.