MEDICARE: NICOLE DANIELLE AMON

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	1041C0700X	Clinical Social Worker		MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679289326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DANIELLE AMON

Provider Business Mailing Address
First Line	:	207 N FRANKLIN ST
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-2303
Country	:	US
Telephone Number	:	988-824-2374
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 N FRANKLIN ST
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-2303
Country	:	US
Telephone Number	:	989-824-2374
Fax Number	:

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

Provider Enumeration Date	:	01/26/2023
Last Update Date	:	01/26/2023

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Directions to “ NICOLE DANIELLE AMON ” Practice Location

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