Basic Information
| Provider Information | |||||||||
| NPI: | 1093111221 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORVATH | ||||||||
| FirstName: | NICHOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2815 ASKIN | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | ONTARIO | ||||||||
| PostalCode: | N9E3J1 | ||||||||
| CountryCode: | CA | ||||||||
| TelephoneNumber: | 5198002605 | ||||||||
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| Practice Location | |||||||||
| Address1: | 26184 OUTER DR | ||||||||
| Address2: | |||||||||
| City: | LINCOLN PARK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481462084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133897525 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2014 | ||||||||
| LastUpdateDate: | 11/16/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | 4704281383 | MI | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.