Provider Demographics
NPI:1528871704
Name:CERVANTES, NICOLE (CCHW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 LONDON AVE
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-2565
Mailing Address - Country:US
Mailing Address - Phone:401-543-4801
Mailing Address - Fax:
Practice Address - Street 1:138 LONDON AVE
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-2565
Practice Address - Country:US
Practice Address - Phone:401-543-4801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker