MEDICARE: NICOLE VAN ALLEN HORNE M.D.

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	208000000X	Pediatrics Physician	1386058527	MI
2	208000000X	Pediatrics Physician	4301105244	MI

General Provider Information

NPI Number	:	1386058527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE VAN ALLEN HORNE M.D.

Provider Business Mailing Address
First Line	:	1865 GEORGETOWN CENTER DR STE A
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7146
Country	:	US
Telephone Number	:	616-457-3510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1865 GEORGETOWN CENTER DR STE A
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7146
Country	:	US
Telephone Number	:	616-457-3510
Fax Number	:

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

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	04/23/2026

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