Provider Demographics
NPI:1003611039
Name:MCCAW, NICOL
Entity type:Individual
Prefix:
First Name:NICOL
Middle Name:
Last Name:MCCAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 N MICHIGAN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4729
Mailing Address - Country:US
Mailing Address - Phone:989-284-2907
Mailing Address - Fax:989-372-9866
Practice Address - Street 1:1227 N MICHIGAN AVE STE 3
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4729
Practice Address - Country:US
Practice Address - Phone:989-284-2907
Practice Address - Fax:989-372-9866
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703117618164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse