Provider Demographics
NPI:1699333419
Name:ZMIJEWSKI, NICOLE ELIZABETH
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:ZMIJEWSKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2090 MATTY DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:MI
Mailing Address - Zip Code:48133-9370
Mailing Address - Country:US
Mailing Address - Phone:419-344-7729
Mailing Address - Fax:
Practice Address - Street 1:2090 MATTY DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:MI
Practice Address - Zip Code:48133-9370
Practice Address - Country:US
Practice Address - Phone:419-344-7729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024629363LF0000X
MI4704241600363LF0000X
DCNP500015068363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0361547Medicaid