Provider Demographics
NPI:1174386353
Name:BILOTTA, NICOLE MICHELLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MICHELLE
Last Name:BILOTTA
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 1:41 SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01436-1363
Mailing Address - Country:US
Mailing Address - Phone:978-833-3117
Mailing Address - Fax:
Practice Address - Street 1:41 SUNRISE DR
Practice Address - Street 2:
Practice Address - City:BALDWINVILLE
Practice Address - State:MA
Practice Address - Zip Code:01436-1363
Practice Address - Country:US
Practice Address - Phone:978-833-3117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN65808164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse