Provider Demographics
NPI:1639611916
Name:BOIVIN, NICOLLE (CPNP-AC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLLE
Middle Name:
Last Name:BOIVIN
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 ST. ANTOINE
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS UHC 5D MAILBOX#
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-966-5051
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3950 BEAUBIEN
Practice Address - Street 2:CHM SPEC CTR. GARDEN LEVEL
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-832-8871
Practice Address - Fax:313-966-7445
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253133363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics