Provider Demographics
NPI:1457793028
Name:WEATHERS, NICOLE ANN (RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:601 W SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862-1328
Mailing Address - Country:US
Mailing Address - Phone:906-233-1322
Mailing Address - Fax:906-233-1220
Practice Address - Street 1:601 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862-1328
Practice Address - Country:US
Practice Address - Phone:906-233-1322
Practice Address - Fax:906-233-1220
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704273785163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health