Provider Demographics
NPI:1558462655
Name:SCZEKAN, NICOLE L (MSN, CNM)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:SCZEKAN
Suffix:
Gender:F
Credentials:MSN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6106
Mailing Address - Country:US
Mailing Address - Phone:176-732-5053
Mailing Address - Fax:
Practice Address - Street 1:83 HERRICK STREET
Practice Address - Street 2:SUITE 2004
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-927-4800
Practice Address - Fax:978-232-5772
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210737176B00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN0220Medicare PIN
MAP59203Medicare UPIN