Healthcare Provider Details

I. General information

NPI: 1881713428
Provider Name (Legal Business Name): MICHELLE I NICOLETTI DNP, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 NEW SANGER AVE STE A
WACO TX
76712-4054
US

IV. Provider business mailing address

PO BOX 21327
WACO TX
76702-1327
US

V. Phone/Fax

Practice location:
  • Phone: 254-399-5400
  • Fax: 254-772-8669
Mailing address:
  • Phone: 254-399-5441
  • Fax: 254-776-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number251376
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: