Provider Demographics
NPI:1528454501
Name:MERRIWEATHER, NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MERRIWEATHER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9632 ASBURY PARK
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1067
Mailing Address - Country:US
Mailing Address - Phone:248-602-6830
Mailing Address - Fax:
Practice Address - Street 1:9632 ASBURY PARK
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1067
Practice Address - Country:US
Practice Address - Phone:248-602-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470303557164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse