Provider Demographics
NPI:1528720729
Name:ROSE CERVANTES, NICOLE AMBER (CNM)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:AMBER
Last Name:ROSE CERVANTES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BOIVIN ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3033
Mailing Address - Country:US
Mailing Address - Phone:518-844-1633
Mailing Address - Fax:
Practice Address - Street 1:584 HOSPITAL DR NE UNIT B
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-0020
Practice Address - Country:US
Practice Address - Phone:910-721-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife