| NPI | 1144623224 |
|---|---|
| Former Name | NICOLE ELIZABETH MICKELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5007225) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 241719) |
| 363L00000X Nurse Practitioner (Licence: NC 241719) | |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2021-04-20 |