Provider Demographics
NPI:1013757087
Name:HARDWICK, NICOLE JANELLE (NP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:JANELLE
Last Name:HARDWICK
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 1:2160 SHILOH HILLS DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8284
Mailing Address - Country:US
Mailing Address - Phone:616-255-6248
Mailing Address - Fax:
Practice Address - Street 1:30600 TELEGRAPH RD STE 1130
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4531
Practice Address - Country:US
Practice Address - Phone:248-621-0370
Practice Address - Fax:248-621-0371
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704270777363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner