Healthcare Provider Details

I. General information

NPI: 1831791375
Provider Name (Legal Business Name): COURTNEY NICHOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 09/14/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 ROSEWOOD N DR
MOUNT PLEASANT MI
48858
US

IV. Provider business mailing address

2408 ROSEWOOD N DR
MOUNT PLEASANT MI
48858
US

V. Phone/Fax

Practice location:
  • Phone: 989-775-3823
  • Fax: 810-275-0307
Mailing address:
  • Phone: 989-775-3823
  • Fax: 810-275-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5601014271
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: