Provider Demographics
NPI:1619176385
Name:O'NEILL, NICOLE JONELLE (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JONELLE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:JONELLE
Other - Last Name:TROMBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2250 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-5318
Mailing Address - Country:US
Mailing Address - Phone:734-780-7070
Mailing Address - Fax:844-633-2487
Practice Address - Street 1:2250 OAK ST
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5318
Practice Address - Country:US
Practice Address - Phone:734-780-7070
Practice Address - Fax:844-633-2487
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301090868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine