NPIMap

Individual provider Active NPI

Nicole Ann Krosnicki, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Sandusky, MI
National Provider Identifier
1134539265
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704257242 Issued in MI
Practice address
170 W Argyle St
Sandusky, MI 48471-1097
Phone
(810) 648-3229
NPI assigned
Apr 29, 2014
Last updated
Feb 24, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704257242 MI Primary

Addresses

Primary practice location

170 W Argyle St
Sandusky, MI 48471-1097

Mailing address

120 N Delaware St
Sandusky, MI 48471-1009
Phone (810) 648-3770

Other names 1

  • Nicole Ann Liccardello Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nicole.demarco@mhs.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140618002424 MI Practitioner - Nurse Practitioner 7911121645 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McKenzie Memorial HospitalGroup PAC ID 6406755289, 31 clinicians
Sciometrix LLCGroup PAC ID 7618367087, 58 clinicians

Practice addresses (Care Compare)

100 Argyle St
Suite 3
Sandusky, MI 48471
Phone (810) 648-6162

120 Delaware St
Sandusky, MI 48471

306 S Washington Ave
Suite 600
Royal Oak, MI 48067-3837
Phone (860) 335-5064

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sciometrix Inc CurrentSince Nov 1, 2024 Accepting new patients
McKenzie Memorial Hospital Current Accepting new patients
Sciometrix LLC CurrentSince Nov 1, 2024 Accepting new patients
McKenzie Memorial Hospital Past Accepting new patients

Locations

8 N Howard Ave
Croswell, MI 48422
Phone (810) 679-0012

306 S Washington Ave
Ste 600
Royal Oak, MI 48067

120 N Delaware St
Sandusky, MI 48471
Phone (810) 648-3770

Interoperability endpoints

  • Direct secure messaging: nicole.demarco@mhs.eclinicaldirectplus.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645660800000",
    "number": "1134539265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 N DELAWARE ST",
            "city": "SANDUSKY",
            "state": "MI",
            "postal_code": "484711009",
            "telephone_number": "810-648-3770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 W ARGYLE ST",
            "city": "SANDUSKY",
            "state": "MI",
            "postal_code": "484711097",
            "telephone_number": "810-648-3229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KROSNICKI",
        "first_name": "NICOLE",
        "middle_name": "ANN",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-29",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704257242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nicole.demarco@mhs.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "170 W Argyle St",
            "city": "Sandusky",
            "state": "MI",
            "country_code": "US",
            "postal_code": "484711097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "LICCARDELLO",
            "middle_name": "ANN",
            "credential": "NP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sandusky, MI

Sources for this page

Verify at the official NPI Registry.