Active NPI
Kimberle S Deller, MS APRN-BC
- Critical Care Medicine Nurse Practitioner
- Dearborn, MI
National Provider Identifier
1194994186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Medicine Nurse Practitioner
- License
- 4704113984
- Practice address
- 18181 Oakwood Blvd
Suite 208
Dearborn, MI 48124-5032 - Phone
- (313) 271-5565
- NPI assigned
- Feb 25, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine Nurse Practitioner | 363LC0200X | 4704113984 | MI | Primary |
Addresses
Primary practice location
18181 Oakwood Blvd
Suite 208
Dearborn, MI 48124-5032
Mailing address
18181 Oakwood Blvd
Suite 208
Dearborn, MI 48124-5032
Phone (313) 271-5565
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4704113984 | Other | MI | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704113984 | MI | MD | Critical Care Medicine Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203897600000",
"number": "1194994186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18181 OAKWOOD BLVD",
"address_2": "SUITE 208",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481245032",
"telephone_number": "313-271-5565"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18181 OAKWOOD BLVD",
"address_2": "SUITE 208",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481245032",
"telephone_number": "313-271-5565"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DELLER",
"first_name": "KIMBERLE",
"middle_name": "S",
"credential": "MS APRN-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-02-25",
"last_updated": "2008-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LC0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Critical Care Medicine",
"state": "MI",
"license": "4704113984",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "4704113984",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.