Provider Demographics
NPI:1073134441
Name:ULRICH, NICOLE M (RN, CCM, CNLCP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:ULRICH
Suffix:
Gender:F
Credentials:RN, CCM, CNLCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 SAINT JUDE DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4357
Mailing Address - Country:US
Mailing Address - Phone:248-674-1028
Mailing Address - Fax:888-551-1057
Practice Address - Street 1:4489 W WALTON BLVD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4076
Practice Address - Country:US
Practice Address - Phone:248-674-1028
Practice Address - Fax:888-551-1057
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704218572163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty