Healthcare Provider Details

I. General information

NPI: 1659960789
Provider Name (Legal Business Name): NICOLE C SONNENBERG AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 KIRKS BLVD STE 100
TROY MI
48084-4135
US

IV. Provider business mailing address

PO BOX 40412
BELFAST ME
04915-1255
US

V. Phone/Fax

Practice location:
  • Phone: 248-824-6500
  • Fax: 248-686-0772
Mailing address:
  • Phone: 248-824-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704258477
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704258477
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: