Provider Demographics
NPI:1245750801
Name:AUDRITSH, NICOLE LYNNE (CNM)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNNE
Last Name:AUDRITSH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNNE
Other - Last Name:MURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:16854 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2174
Mailing Address - Country:US
Mailing Address - Phone:734-751-5056
Mailing Address - Fax:
Practice Address - Street 1:4669 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2709
Practice Address - Country:US
Practice Address - Phone:313-416-6200
Practice Address - Fax:313-221-9799
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704291959163W00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse