Healthcare Provider Details

I. General information

NPI: 1750236519
Provider Name (Legal Business Name): NICOLE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23300 PROVIDENCE DR
SOUTHFIELD MI
48075-3652
US

IV. Provider business mailing address

23300 PROVIDENCE DR
SOUTHFIELD MI
48075-3652
US

V. Phone/Fax

Practice location:
  • Phone: 313-929-9750
  • Fax:
Mailing address:
  • Phone: 313-929-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: