Basic Information
| Provider Information | |||||||||
| NPI: | 1427431402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DACAMPO | ||||||||
| FirstName: | NICOLE | ||||||||
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| Credential: | MSN, APRN, WHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 JAYCIN CIR | ||||||||
| Address2: | |||||||||
| City: | WOBURN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018013907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7816401602 | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 LIBERTY ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011031114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4132717136 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2015 | ||||||||
| LastUpdateDate: | 08/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN2299116 | MA | N | Nursing Service Providers | Registered Nurse | 363LW0102X | RN2299116 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.