MEDICARE: NICOLE ELIZABETH ZMIJEWSKI

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	APRN.CNP.024629	OH
2	363LF0000X	Family Nurse Practitioner	4704241600	MI
3	363L00000X	Nurse Practitioner	NP500015068	DC

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	:	1699333419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE ELIZABETH ZMIJEWSKI

Provider Business Mailing Address
First Line	:	2090 MATTY DR
Second Line	:
City	:	ERIE
State	:	MI
Zip	:	48133-9370
Country	:	US
Telephone Number	:	419-344-7729
Fax Number	:

Provider Business Practice Location Address
First Line	:	2090 MATTY DR
Second Line	:
City	:	ERIE
State	:	MI
Zip	:	48133-9370
Country	:	US
Telephone Number	:	419-344-7729
Fax Number	:

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

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	03/14/2025

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