Provider Demographics
NPI:1104383280
Name:DRAPER, NINA SUE (RN)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:SUE
Last Name:DRAPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11059 E FILLMORE RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:MI
Mailing Address - Zip Code:48847-9532
Mailing Address - Country:US
Mailing Address - Phone:989-763-9076
Mailing Address - Fax:
Practice Address - Street 1:11059 E FILLMORE RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:MI
Practice Address - Zip Code:48847-9532
Practice Address - Country:US
Practice Address - Phone:989-763-9076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704296214163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse