Provider Demographics
NPI:1528676525
Name:HUBER, NICOLE LYNNETTE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNNETTE
Last Name:HUBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 S 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48634-9766
Mailing Address - Country:US
Mailing Address - Phone:989-415-1087
Mailing Address - Fax:
Practice Address - Street 1:2506 ABBOTT RD APT P11
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-5004
Practice Address - Country:US
Practice Address - Phone:989-415-1087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide