MEDICARE: NICOLE MARIE NOTTER

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
1	363LA2200X	Adult Health Nurse Practitioner	4704348272	MI

General Provider Information

NPI Number	:	1205793387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE NOTTER

Provider Business Mailing Address
First Line	:	5179 WINSHALL DR
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-1222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 HEALTH PARK BLVD STE E
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2558
Country	:	US
Telephone Number	:	810-603-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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Directions to “ NICOLE MARIE NOTTER ” Practice Location

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