Active NPI
Ethan Cicero, PHD, RN
- General Practice Registered Nurse
- Watertown, MA
National Provider Identifier
1639934789
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Registered Nurse
- License
- RN10003654
- Practice address
- 53 Carver Rd
Watertown, MA 02472-1312 - Phone
- (561) 703-0594
- NPI assigned
- Feb 19, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | RN10003654 | MA | Primary |
Addresses
Primary practice location
53 Carver Rd
Watertown, MA 02472-1312
Mailing address
53 Carver Rd
Watertown, MA 02472-1312
Phone (561) 703-0594
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN10003654 | MA | MD | General Practice Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738540800000",
"number": "1639934789",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "53 CARVER RD",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024721312",
"telephone_number": "561-703-0594"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "53 CARVER RD",
"city": "WATERTOWN",
"state": "MA",
"postal_code": "024721312",
"telephone_number": "561-703-0594"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CICERO",
"first_name": "ETHAN",
"name_prefix": "Dr.",
"credential": "PHD, RN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-02-19",
"last_updated": "2025-02-03",
"certification_date": "2025-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "MA",
"license": "RN10003654",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.