Most Relevant Information
Provider Data
| NPI Number: | 1003372475 |
| Provider Name: | NICHOLE ELAINE ROBERTS FNP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 71008738A |
Most Important Dates
| Enumeration Date: | 02/11/2019 |
| Last Updated: | 09/14/2023 |
Provider Practice Location
9470 BROADWAY
CROWN POINT
IN
463075722
Practice Location Phone/Fax
| Phone: | 2196613260 |
| Fax: | 2196623770 |
Provider Mailing Location
PO BOX 781076
DETROIT
MI
482781076
Provider Mailing Phone/Fax
| Phone: | 3175284800 |
| Fax: | 3178651479 |