Derucki, Carole Anne

Derucki, Carole Anne is an individual health care provider with primary practice located at 2900 Lakeview Ave , Saint Joseph MI 49085-2379. She recently has 3 registered licenses in different health care specialties including Other Service Providers / Specialist, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Derucki, Carole Anne can be contacted via phone (269) 932-7859.

Contact Information

Primary practice address
2900 Lakeview Ave Saint Joseph MI 49085-2379
Phone: (269) 932-7859
Fax: (269) 932-7859
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 71002723A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 4704166108 Michigan
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 71002723A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 4704166108 Michigan

Profile Details

NPI number 1205809225
LBN Legal business name Derucki, Carole Anne
Credentials FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 9th, 2006
Last updated Feb 29th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205809225 NPPES
Michigan MEDICAID 478536310
Michigan MEDICAID 200917690A
Michigan Other 000000723347
Michigan MEDICAID 200917690
Michigan Other 4704166108

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