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Contact Information

NICOLE I BACK
5758 COOLEY LAKE RD
WATERFORD TOWNSHIP, MI48327-3073
 Phone: 855-466-3631
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family

363LF0000X 50 Nurse Practitioner
 

Registered Nurse

163W00000X
Indicates primary specialty

NPI Profile & details for NICOLE I BACK · (Female)

NPI Number 1013756576
Status Active
Credentials
Entity Individual
Enumeration date 05/23/2024
Last updated 03/06/2025 - More than a year ago
Sole proprietor 1 No
Identifiers
  • MI License # 4704247636
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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