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General NPI Number Information
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NPI Number | 1508671199
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Entity Type | Individual
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Provider Name | NICOLE NEGUS NP
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Gender | Female
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1639 N ALPINE RD FL 3
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City | ROCKFORD
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State | IL
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Zip | 61107-1449
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Country | US
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Telephone | 815-229-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 469 W HURON ST APT 1804
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City | CHICAGO
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State | IL
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Zip | 60654-3470
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Country | US
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Telephone | 608-751-9457
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.031613
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License Number State | IL
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