Healthcare Provider Details

I. General information

NPI: 1285287201
Provider Name (Legal Business Name): NICOLE ELIZABETH LOTZE RN BSN MSN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2019
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DETROIT MEDICAL CENTER 3990 JOHN R
DEROIT MI
48201
US

IV. Provider business mailing address

DETROIT MEDICAL CENTER 3990 JOHN R
DEROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-8525
  • Fax:
Mailing address:
  • Phone: 313-745-8525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704279059
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: