Provider Demographics
NPI:1487806105
Name:MOTLEY, NICOLE F (RN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:F
Last Name:MOTLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 WILLMOR ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-4069
Mailing Address - Country:US
Mailing Address - Phone:262-412-0077
Mailing Address - Fax:
Practice Address - Street 1:708 WILLMOR ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-4069
Practice Address - Country:US
Practice Address - Phone:262-412-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI153423-30163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse