Healthcare Provider Details

I. General information

NPI: 1851154017
Provider Name (Legal Business Name): NICOLE URBON AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20095 GILBERT RD
BIG RAPIDS MI
49307-2365
US

IV. Provider business mailing address

16220 ALMY RD
HOWARD CITY MI
49329-9127
US

V. Phone/Fax

Practice location:
  • Phone: 231-592-1360
  • Fax:
Mailing address:
  • Phone: 616-799-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number4704299091
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704299091
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: