MRS. CAROLE ANNE DERUCKI FNP-BC NPI 1205809225

NPI Information

NPI: 1205809225
Provider Name: MRS. CAROLE ANNE DERUCKI, FNP-BC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
2900 LAKEVIEW AVE
SAINT JOSEPH, MI
ZIP 49085
Phone: (269) 932-7859
Get Directions

MRS. Carole Anne Derucki, FNP-BC is a family nurse practitioner in Saint Joseph, MI with 19 years of experience. MRS. Carole Anne Derucki, FNP-BC NPI is 1205809225. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2900 LAKEVIEW AVE
SAINT JOSEPH, MI
ZIP 49085-379
Phone: (269) 932-7859
Fax: (269) 932-7859

The NPI 1205809225 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/9/2006 and was last updated on 2/29/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		71002723A	INDIANA	No
2	363L00000X	Nurse Practitioner		4704166108	MICHIGAN	No
3	363L00000X	Nurse Practitioner		71002723A	INDIANA	No
4	363LF0000X	Nurse Practitioner	Family	4704166108	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	478536310	MEDICAID	MICHIGAN
2	200917690A	MEDICAID	INDIANA
3	000000723347	OTHER	INDIANA	BCBS
4	200917690	MEDICAID	INDIANA
5	4704166108	OTHER	MICHIGAN	MICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

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