Healthcare Provider Details

I. General information

NPI: 1033041512
Provider Name (Legal Business Name): MERIROSE NINA BASILLOTE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ARMSTRONG RD
BATTLE CREEK MI
49037-7314
US

IV. Provider business mailing address

48270 SILVER OAKS BLVD
MATTAWAN MI
49071-7826
US

V. Phone/Fax

Practice location:
  • Phone: 269-569-0924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704368355
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: