Nicole Irene Back
Nurse Practitioner, Family in Waterford, MI. Individual provider (NPI-1).
NPI number1013756576
StatusActive
Last updated in NPPESMar 6, 2025
Details
- NPI
- 1013756576
- Entity type
- Individual (NPI-1)
- Name
- Nicole Irene Back
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- May 23, 2024
- Certification date
- Mar 6, 2025
- Last updated
- Mar 6, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - NURSE PRACTITIONER
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 4704247636 | MI | Yes |
| 163W00000X | Registered Nurse | 4704247636 | MI |
Practice location
5758 Cooley Lake RdWaterford, MI 48327-3073
Phone 855-466-3631
Mailing address
5758 Cooley Lake RdWaterford, MI 48327-3073
Phone 855-466-3631
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 33 Family Nurse Practitioner providers in Waterford · All 1,575 providers in Waterford
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