Provider Demographics
NPI:1184487753
Name:NICKEL, KELLEY A (CPRM CPS RN)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:A
Last Name:NICKEL
Suffix:
Gender:F
Credentials:CPRM CPS RN
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:A
Other - Last Name:MARSHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:960 M 60 E
Mailing Address - Street 2:
Mailing Address - City:CASSOPOLIS
Mailing Address - State:MI
Mailing Address - Zip Code:49031-9339
Mailing Address - Country:US
Mailing Address - Phone:269-445-2451
Mailing Address - Fax:269-445-3836
Practice Address - Street 1:960 M 60 E
Practice Address - Street 2:
Practice Address - City:CASSOPOLIS
Practice Address - State:MI
Practice Address - Zip Code:49031-9339
Practice Address - Country:US
Practice Address - Phone:269-445-2451
Practice Address - Fax:269-445-3836
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist