Provider Demographics
NPI:1487211165
Name:RYE, NICOLE (DO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:RYE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10740 DIXIE HWY STE B
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-1123
Mailing Address - Country:US
Mailing Address - Phone:810-425-8921
Mailing Address - Fax:810-776-5071
Practice Address - Street 1:10740 DIXIE HWY STE B
Practice Address - Street 2:
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350-1123
Practice Address - Country:US
Practice Address - Phone:810-425-8921
Practice Address - Fax:810-776-5071
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101026230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine