Healthcare Provider Details

I. General information

NPI: 1679383855
Provider Name (Legal Business Name): NICOLE BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S FERRIS RD
SUMNER MI
48889-9707
US

IV. Provider business mailing address

1225 S FERRIS RD
SUMNER MI
48889-9707
US

V. Phone/Fax

Practice location:
  • Phone: 989-436-2903
  • Fax:
Mailing address:
  • Phone: 989-436-2903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: