Provider Demographics
NPI:1144774019
Name:ABBGY, NICOLE RENEE (NP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:ABBGY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:ZERFAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5008
Mailing Address - Country:US
Mailing Address - Phone:616-685-1808
Mailing Address - Fax:616-685-8099
Practice Address - Street 1:300 LAFAYETTE AVE SE
Practice Address - Street 2:SUITE 3000
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4692
Practice Address - Country:US
Practice Address - Phone:616-685-6919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704224350363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health