Provider Demographics
NPI:1134482342
Name:FICK, NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FICK
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 1:3271 GERMAN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIAVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48421-8989
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3271 GERMAN RD
Practice Address - Street 2:
Practice Address - City:COLUMBIAVILLE
Practice Address - State:MI
Practice Address - Zip Code:48421-8989
Practice Address - Country:US
Practice Address - Phone:810-955-2684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704290597163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse