Unknown Individual – Primary Care Nurse Practitioner, NPI 1366964157

Unknown Individual is a healthcare provider. based in Macomb, Michigan. specializing in Primary Care Nurse Practitioner. They hold a License No. 4704255929 (MI). The NPI Number for Unknown Individual is 1366964157

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1366964157
Phone
(586) 569-3954
Address
48643 STONEACRE DR
Deactivation Date
6 January 2021
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Stoneacre Drive, Macomb Township, Macomb County, Michigan, 48044, United States

    MACOMB, MI 480441884

    Phone: (586) 569-3954

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 48044)

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Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1366964157.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Primary Care Nurse Practitioner is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Macomb, Michigan in the data we show; additional addresses may exist on the full record.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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