Healthcare Provider Details

I. General information

NPI: 1871008821
Provider Name (Legal Business Name): NICOLE R TOWNS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE PRATTE NP

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5656 W US HIGHWAY 10
LUDINGTON MI
49431-2454
US

IV. Provider business mailing address

PO BOX 776982
CHICAGO IL
60677-6982
US

V. Phone/Fax

Practice location:
  • Phone: 231-843-2543
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704293715
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: