Healthcare Provider Details

I. General information

NPI: 1073926671
Provider Name (Legal Business Name): NICOLE RING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 HONEY CREEK CIRCLE
PLAIN WI
53577
US

IV. Provider business mailing address

1675 HONEY CREEK CIRCLE P.O. BOX 61
PLAIN WI
53577
US

V. Phone/Fax

Practice location:
  • Phone: 608-588-4033
  • Fax:
Mailing address:
  • Phone: 608-588-4033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number318143-31
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA302238
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: