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General NPI Number Information
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NPI Number | 1538828223
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Entity Type | Individual
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Provider Name | NICOLETTE VANMALDEGHEM DNP, RN, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 5280 METROPOLITAN PKWY
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-4005
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Country | US
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Telephone | 586-722-7519
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Fax |
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Provider Business Mailing Address
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Address Line | 47450 JUNIPER RD
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City | MACOMB
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State | MI
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Zip | 48044-2434
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Country | US
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Telephone | 248-495-9859
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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 | 4704329215
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License Number State | MI
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