Provider Demographics
NPI:1588853501
Name:EPPERLY, NICOLE ANN (LLBSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:EPPERLY
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7260 SMITHS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-4018
Mailing Address - Country:US
Mailing Address - Phone:810-347-2694
Mailing Address - Fax:
Practice Address - Street 1:515 S PARKER ST
Practice Address - Street 2:#D
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-3572
Practice Address - Country:US
Practice Address - Phone:810-765-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802086113171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator