Provider Demographics
NPI:1306175351
Name:NIKOLAUK, EMILY ANN (ACNP-BC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:NIKOLAUK
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22101 MOROSS RD
Mailing Address - Street 2:INTERNAL MEDICINE DEPARTMENT
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2148
Mailing Address - Country:US
Mailing Address - Phone:313-343-3362
Mailing Address - Fax:313-343-7784
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:INTERNAL MEDICINE DEPARTMENT
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2148
Practice Address - Country:US
Practice Address - Phone:313-343-3362
Practice Address - Fax:313-343-7784
Is Sole Proprietor?:No
Enumeration Date:2009-12-21
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704216668363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI500H217410OtherBCBS GROUP NUMBER
MI500H217410OtherBCBS GROUP NUMBER