Provider Demographics
NPI:1619006145
Name:NIZIOLEK, CAROL ANN (RN,MSN,CS)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:NIZIOLEK
Suffix:
Gender:F
Credentials:RN,MSN,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MERRYMEETING DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3938
Mailing Address - Country:US
Mailing Address - Phone:207-797-7479
Mailing Address - Fax:
Practice Address - Street 1:121 MIDDLE ST
Practice Address - Street 2:SUITE 404
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4156
Practice Address - Country:US
Practice Address - Phone:207-772-8534
Practice Address - Fax:207-772-1629
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER 032287364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent