Healthcare Provider Details

I. General information

NPI: 1699333419
Provider Name (Legal Business Name): NICOLE ELIZABETH ZMIJEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ELIZABETH KNIGHT

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 MATTY DR
ERIE MI
48133-9370
US

IV. Provider business mailing address

2090 MATTY DR
ERIE MI
48133-9370
US

V. Phone/Fax

Practice location:
  • Phone: 419-344-7729
  • Fax:
Mailing address:
  • Phone: 419-344-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024629
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704241600
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP500015068
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: