Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicole Dettmann, PA

Individual provider Physician Assistant · NPI 1619931813

Nicole Dettmann, PA is a Physician Assistant in Boston, Massachusetts. Licensed in Massachusetts. Registered with an NPI since 2006.

Licensed in
MA
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

133 Brookline Ave
Boston, MA 02215-3904
Phone: (617) 421-1000
Fax: (617) 421-6084
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 1603 (MA)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 1603 (MA)

Record details

NPI number1619931813
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedApril 14, 2006
Last updated in NPPESAugust 7, 2007
Mailing address147 Milk St, Provider Enrollment - 9th Floor, Boston, MA 02109-4806

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