Provider Demographics
NPI:1962885806
Name:METCALF, NICOLE BRODY (MSN, RN, CPNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:BRODY
Last Name:METCALF
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:BRODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:295C KENNEDY MEMORIAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4535
Mailing Address - Country:US
Mailing Address - Phone:207-873-5437
Mailing Address - Fax:207-861-5448
Practice Address - Street 1:295C KENNEDY MEMORIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4535
Practice Address - Country:US
Practice Address - Phone:207-873-5437
Practice Address - Fax:207-861-5448
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP201210363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics