Provider Demographics
NPI:1861734816
Name:DEGREE, NICHOLE ANGILIC (LPN)
Entity type:Individual
Prefix:MISS
First Name:NICHOLE
Middle Name:ANGILIC
Last Name:DEGREE
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 1:1431 WASHINGTON BLVD APT 2306
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-1728
Mailing Address - Country:US
Mailing Address - Phone:414-630-0379
Mailing Address - Fax:
Practice Address - Street 1:1431 WASHINGTON BLVD APT 2306
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-1728
Practice Address - Country:US
Practice Address - Phone:414-630-0379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-17
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309638-31164W00000X
MI4703119998164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse