Healthcare Provider Details

I. General information

NPI: 1043747876
Provider Name (Legal Business Name): NICOLE ELLIS SHERWOOD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2366 OAK VALLEY DR
ANN ARBOR MI
48103-8944
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 877-227-8823
  • Fax: 313-578-6393
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704329104
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: