Provider Demographics
NPI:1356005029
Name:KUSMIERZ, NICOLE CLAIRE (FNP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:CLAIRE
Last Name:KUSMIERZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 RANSOM DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-6007
Mailing Address - Country:US
Mailing Address - Phone:970-485-3136
Mailing Address - Fax:
Practice Address - Street 1:16717 HIGHWAY 17 N
Practice Address - Street 2:SUITE 206
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443
Practice Address - Country:US
Practice Address - Phone:910-270-0052
Practice Address - Fax:910-270-0660
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine