Provider Demographics
NPI:1619678729
Name:RANSBERGER, NICHOLE (LPN)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:RANSBERGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 ELECIA DR
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-1625
Mailing Address - Country:US
Mailing Address - Phone:810-300-0869
Mailing Address - Fax:
Practice Address - Street 1:3161 ELECIA DR
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-1625
Practice Address - Country:US
Practice Address - Phone:810-300-0869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703123072164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse