Healthcare Provider Details

I. General information

NPI: 1043737182
Provider Name (Legal Business Name): NICOLE JUNE KRUMMEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 PARKWAY NORTH BLVD STE C
CUMMING GA
30040-1431
US

IV. Provider business mailing address

5965 PARKWAY NORTH BLVD STE C
CUMMING GA
30040-1431
US

V. Phone/Fax

Practice location:
  • Phone: 770-886-5700
  • Fax:
Mailing address:
  • Phone: 770-886-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number232335
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: