Provider Demographics
NPI:1851154017
Name:URBON, NICOLE (AGNP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:URBON
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16220 ALMY RD
Mailing Address - Street 2:
Mailing Address - City:HOWARD CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49329-9127
Mailing Address - Country:US
Mailing Address - Phone:616-799-2161
Mailing Address - Fax:
Practice Address - Street 1:20095 GILBERT RD
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2365
Practice Address - Country:US
Practice Address - Phone:231-592-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704299091207QA0505X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine