Provider Demographics
NPI:1073335857
Name:CHIMIRRI-HALEY, NICOLE LORRAINE (RN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LORRAINE
Last Name:CHIMIRRI-HALEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 MERLINE RD
Mailing Address - Street 2:
Mailing Address - City:VERNON ROCKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4025
Mailing Address - Country:US
Mailing Address - Phone:508-331-5322
Mailing Address - Fax:
Practice Address - Street 1:417 COPPERMILL RD
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4075
Practice Address - Country:US
Practice Address - Phone:860-257-9462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT224499163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice