Healthcare Provider Details

I. General information

NPI: 1205793387
Provider Name (Legal Business Name): NICOLE MARIE NOTTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HEALTH PARK BLVD STE E
GRAND BLANC MI
48439-2558
US

IV. Provider business mailing address

5179 WINSHALL DR
SWARTZ CREEK MI
48473-1222
US

V. Phone/Fax

Practice location:
  • Phone: 810-603-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704348272
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: