Individual
NICOLE MICHELLE WEICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14555 LEVAN RD, SUITE 311, LIVONIA, MI 48154-5083
(734) 655-2692
Mailing address
42935 WHITESTONE CT, NORTHVILLE, MI 48168-2061
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
5601005104
MI
363AS0400X
Surgical Physician Assistant
Primary
5601005104
MI
Other
Enumeration date
10/30/2008
Last updated
01/30/2012
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