Individual
MRS. ANGELA M NICKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4025 HEALTH PARK LN, SAINT JOSEPH, MI 49085-3421
(269) 429-7100
(269) 429-1959
Mailing address
4025 HEALTH PARK LN, SAINT JOSEPH, MI 49085-3421
(269) 429-7100
(269) 429-1959
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704221750
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326401639
—
MI
01
—
4704221750
LICENSE
MI
Enumeration date
04/04/2016
Last updated
05/23/2016
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