Individual
NICOLE ROSE KNISLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1600 S CANTON CENTER RD, #140, CANTON, MI 48188-1992
(734) 398-7561
(734) 398-7566
Mailing address
1600 S CANTON CENTER RD, #140, CANTON, MI 48188-1992
(734) 398-7561
(734) 398-7566
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601006025
MI
Other
Enumeration date
06/27/2011
Last updated
07/28/2014
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