Healthcare Provider Details

I. General information

NPI: 1205798717
Provider Name (Legal Business Name): NICOLE MARIE LIKE AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 DEMING WAY STE 400
MIDDLETON WI
53562-4662
US

IV. Provider business mailing address

2342 HOARD ST # 1
MADISON WI
53704-4953
US

V. Phone/Fax

Practice location:
  • Phone: 608-820-1646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number17734-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: