Provider Demographics
NPI:1164040978
Name:CREPPEL, NICOLE HENRY (MD)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:HENRY
Last Name:CREPPEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:HENRY
Other - Last Name:CREPPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:675 N. ST. CLAIR
Mailing Address - Street 2:GALTER PAVILION, 15TH FLOOR, ROOM 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:504-273-3830
Mailing Address - Fax:
Practice Address - Street 1:675 N. ST. CLAIR
Practice Address - Street 2:GALTER PAVILION, 15TH FLOOR, ROOM 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-695-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2022-10-11
Deactivation Date:2022-03-30
Deactivation Code:
Reactivation Date:2022-05-24
Provider Licenses
StateLicense IDTaxonomies
IL125079594207Y00000X
TN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program