Provider Demographics
NPI:1326933003
Name:BOSTON, NICOLE LYNN
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:LYNN
Last Name:BOSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 UNIVERSITY DR LOT 1003
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6610
Mailing Address - Country:US
Mailing Address - Phone:701-969-7625
Mailing Address - Fax:
Practice Address - Street 1:1119 UNIVERSITY DR LOT 1003
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6610
Practice Address - Country:US
Practice Address - Phone:701-969-7625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant