Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704303156 | MI |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 4704303156 | MI |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | 4704303156 | MI |
NPI | 1063810216 |
---|---|
Provider Name | Nicole Sovey |
First Address | Hartland, MI 48353-2702 |
Second Address | Hartland, MI 48353-2702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2014 |
Last Update Date | 10/03/2015 |