Nicole Ann Bluethgen, FNP, RN
Nurse Practitioner, Family in Stony Brook, NY. Individual provider (NPI-1).
NPI number1104701911
StatusActive
Last updated in NPPESAug 11, 2025
Details
- NPI
- 1104701911
- Entity type
- Individual (NPI-1)
- Name
- Nicole Ann Bluethgen
- Credential
- FNP, RN
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 11, 2025
- Certification date
- Aug 10, 2025
- Last updated
- Aug 11, 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 | 357425 | NY | Yes |
Practice location
101 Nicolls RdStony Brook, NY 11794-0001
Phone 631-689-8333
Mailing address
1 Mohannis WayKings Park, NY 11754-4547
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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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