Healthcare Provider Details

I. General information

NPI: 1114119617
Provider Name (Legal Business Name): NICOLE M MILLIKEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 09/17/2022
Certification Date: 09/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

1540 LAKE LANSING RD STE G6
LANSING MI
48912-3757
US

V. Phone/Fax

Practice location:
  • Phone: 517-482-7246
  • Fax: 517-484-7377
Mailing address:
  • Phone: 517-482-7246
  • Fax: 517-484-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP 09499
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704307959
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: