Healthcare Provider Details

I. General information

NPI: 1083545701
Provider Name (Legal Business Name): DEBRA A NICHOLS-WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SELMA ST
CADILLAC MI
49601-1754
US

IV. Provider business mailing address

421 SELMA ST
CADILLAC MI
49601-1754
US

V. Phone/Fax

Practice location:
  • Phone: 231-884-4292
  • Fax:
Mailing address:
  • Phone: 231-884-4292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number5802000231
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: