Healthcare Provider Details

I. General information

NPI: 1437403482
Provider Name (Legal Business Name): NICOLE R FERRARI PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 FULLER RD
ANN ARBOR MI
48105-2303
US

IV. Provider business mailing address

38935 ANN ARBOR RD CREDENTIALING DEPT
LIVONIA MI
48150-3397
US

V. Phone/Fax

Practice location:
  • Phone: 734-222-7685
  • Fax:
Mailing address:
  • Phone: 888-861-8740
  • Fax: 866-250-6385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006575
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: