Individual
NICOLE L NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
LIFESTANCE HEALTH, 7300 DIXIE HWY., CLARKSTON, MI 48346
(248) 922-2300
(248) 922-2304
Mailing address
LIFESTANCE HEALTH, 7300 DIXIE HWY., CLARKSTON, MI 48346
(248) 922-2300
(248) 922-2304
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704296871
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704296871
MI
Other
Enumeration date
02/26/2014
Last updated
02/02/2023
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