Provider Demographics
NPI:1083153332
Name:MCLEAN, NIKOLE M (NP)
Entity type:Individual
Prefix:
First Name:NIKOLE
Middle Name:M
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 N LAPEER RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48461-9660
Mailing Address - Country:US
Mailing Address - Phone:810-270-9301
Mailing Address - Fax:810-270-9302
Practice Address - Street 1:5830 N LAPEER RD STE B
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48461-9660
Practice Address - Country:US
Practice Address - Phone:810-270-9301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704246079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily