Nicole Roth, PA
Individual provider Active NPI Physician Assistant · Munising, MI
NPI 1831447770 · NPPES record last updated Jul 2, 2013
Key facts
- NPI
- 1831447770
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601006425 (MI)
- Practice address
- 1500 Sandpoint Rd
Munising, MI 49862-1406 - Phone
- (906) 387-4110
- NPI assigned
- Aug 27, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130121000144 | MI | Practitioner - Physician Assistant | 6204089451 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 906 Footcare PLLC | Physician Assistant | Current |
Accepting new patients |
| Munising Memorial Hospital Association | Physician Assistant | Past | Accepting new patients |
| Munising Memorial Hospital Association | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601006425 | MI | Yes |
Addresses
Primary practice location
1500 Sandpoint Rd
Munising, MI 49862-1406
Mailing address
1500 Sandpoint Rd
Munising, MI 49862-1406
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23-8650 | Other | MI | RHC CERTIFICATION NUMBER |
Other names
- Nicole Aninos
Other providers in Munising, MI
- Kerrie Phillipson
- Jan Hazel Prokosch
- Emily Rose Prunick
- Putvin Health Mart of Munising Inc
- Chelsea Elise Ray
- Walter William Rudzinski
- Kareem Said
- Sault Tribe of Chippewa Indians
- George Schultz
- Joseph Michael Shaw II
All providers in Munising, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.