MEDICARE: NICOLE MARIE LIKE AGNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	17734-33	WI

General Provider Information

NPI Number	:	1205798717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE LIKE AGNP-C

Provider Business Mailing Address
First Line	:	29624 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1296
Country	:	US
Telephone Number	:	608-756-6868
Fax Number	:	608-756-6289

Provider Business Practice Location Address
First Line	:	1350 DEMING WAY STE 400
Second Line	:
City	:	MIDDLETON
State	:	WI
Zip	:	53562-4662
Country	:	US
Telephone Number	:	608-820-1646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	02/09/2026

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Directions to “ NICOLE MARIE LIKE AGNP-C” Practice Location

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