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NPI Code Detail

MEDICARE: NICOLE MARIE TOMPKINS PA

MEDICARE:   NICOLE MARIE TOMPKINS  PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant5601007257MI

General Provider Information

NPI Number : 1003213786
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE MARIE TOMPKINS PA
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE
Second Line : MC845
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 922 LAWNDALE ST
Second Line :
City : LUDINGTON
State : MI
Zip : 49431-1928
Country : US
Telephone Number : 231-845-7380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2014
Last Update Date : 07/31/2024

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Directions to “ NICOLE MARIE TOMPKINS PA” Practice Location

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