Provider Demographics
NPI:1124787759
Name:BRETHERTON, NICOLA KATHERINE (NP)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:KATHERINE
Last Name:BRETHERTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NICOLA
Other - Middle Name:KATHERINE
Other - Last Name:DONOHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 PINEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-3311
Mailing Address - Country:US
Mailing Address - Phone:781-540-1939
Mailing Address - Fax:
Practice Address - Street 1:201 QUINCY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2926
Practice Address - Country:US
Practice Address - Phone:508-580-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2326801363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics