Active NPI
Nicole Smith
- Gerontology Nurse Practitioner
- Utica, MI
National Provider Identifier
1306526371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 4704251288
- Practice address
- 12786 Mandalay Cir
Utica, MI 48315-6839 - Phone
- (313) 729-3305
- NPI assigned
- Jul 24, 2023
- Last updated
- Jul 24, 2023
- 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 |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 4704251288 | MI | Primary |
Addresses
Primary practice location
12786 Mandalay Cir
Utica, MI 48315-6839
Mailing address
12786 Mandalay Cir
Utica, MI 48315-6839
Phone (313) 729-3305
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704251288 | MI | MD | Gerontology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690156800000",
"number": "1306526371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12786 MANDALAY CIR",
"city": "UTICA",
"state": "MI",
"postal_code": "483156839",
"telephone_number": "313-729-3305"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12786 MANDALAY CIR",
"city": "UTICA",
"state": "MI",
"postal_code": "483156839",
"telephone_number": "313-729-3305"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-24",
"last_updated": "2023-07-24",
"certification_date": "2023-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "MI",
"license": "4704251288",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Utica, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.