MEDICARE: NICHOLE ELIZABETH WASHINGTON FNP-BC

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	363LF0000X	Family Nurse Practitioner	4704254664	MI

General Provider Information

NPI Number	:	1528338142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE ELIZABETH WASHINGTON FNP-BC

Provider Business Mailing Address
First Line	:	245 CHERRY ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-4607
Country	:	US
Telephone Number	:	616-685-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 44TH ST SE
Second Line	:
City	:	KENTWOOD
State	:	MI
Zip	:	49508-5299
Country	:	US
Telephone Number	:	616-685-8100
Fax Number	:

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

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	12/14/2021

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