Healthcare Provider Details

I. General information

NPI: 1063810216
Provider Name (Legal Business Name): NICOLE SOVEY MSN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE ERRIDGE MSN, WHNP-BC

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11166 HIGHLAND RD
HARTLAND MI
48353-2702
US

IV. Provider business mailing address

11166 HIGHLAND RD
HARTLAND MI
48353-2702
US

V. Phone/Fax

Practice location:
  • Phone: 810-632-0092
  • Fax: 810-632-0308
Mailing address:
  • Phone: 810-632-0092
  • Fax: 810-632-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704303156
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704303156
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number4704303156
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: