Healthcare Provider Details

I. General information

NPI: 1023938412
Provider Name (Legal Business Name): NICOLE MARY HAMWAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N MAIN ST UNIT 612
ROYAL OAK MI
48067-4124
US

IV. Provider business mailing address

350 N MAIN ST UNIT 612
ROYAL OAK MI
48067-4124
US

V. Phone/Fax

Practice location:
  • Phone: 810-599-3970
  • Fax:
Mailing address:
  • Phone: 810-599-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704354580
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: