Carolyn Gagacki, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704100427 Issued in MI

Practice address

Presbyterian Village - East
33875 Kiely Drive
Chesterfield, MI 48407

Phone

(810) 725-6030

NPI assigned

Jul 19, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Specialist, Nurse Practitioner

Practice roles

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.

• University Physician Group

  dba Wayne Health

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1447299797
  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346269479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 WOODWARD AVE",
            "address_2": "SUITE 702",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012061",
            "telephone_number": "313-262-1303",
            "fax_number": "313-262-1238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PRESBYTERIAN VILLAGE - EAST",
            "address_2": "33875 KIELY DRIVE",
            "city": "CHESTERFIELD",
            "state": "MI",
            "postal_code": "48407",
            "telephone_number": "810-725-6030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGACKI",
        "first_name": "CAROLYN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704100427",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miah Elizabeth Fulton
• Bryanna Furby
• Erika Furlow
• Nicole Furtah
• Deborah Ann Furton, R.S.S.T.
• Jennifer Gagne
• Alyssa Gailliard
• Debra Gainor, MA, LLP
• Laci Galante
• Noah Gallagher

• Nurse Practitioner in Chesterfield, MI
• Providers in Chesterfield, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.