Healthcare Provider Details

I. General information

NPI: 1538730064
Provider Name (Legal Business Name): CASE MANAGEMENT SERVCIES BY NICOLE NOWICKI RN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4489 W WALTON BLVD
WATERFORD MI
48329-4076
US

IV. Provider business mailing address

4489 W WALTON BLVD
WATERFORD MI
48329-4076
US

V. Phone/Fax

Practice location:
  • Phone: 248-224-5010
  • Fax: 888-551-1057
Mailing address:
  • Phone: 248-224-5010
  • Fax: 888-551-1057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. NICOLE MARY ULRICH
Title or Position: CEO
Credential: RN, CCM, CNLCP
Phone: 248-224-5010