Provider Demographics
NPI:1821466277
Name:NICKOLAOU, CHERYL ELAINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ELAINE
Last Name:NICKOLAOU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8284 PEACEFUL VLY
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-2644
Mailing Address - Country:US
Mailing Address - Phone:248-884-6699
Mailing Address - Fax:
Practice Address - Street 1:8284 PEACEFUL VLY
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-2644
Practice Address - Country:US
Practice Address - Phone:248-884-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704217545363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily