MEDICARE: MS. JUDITH ANNE PLECHA R.N.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	4704115055	MI

General Provider Information

NPI Number	:	1649300013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH ANNE PLECHA R.N.

Provider Business Mailing Address
First Line	:	1407 NOWLIN ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2607
Country	:	US
Telephone Number	:	313-563-3945
Fax Number	:

Provider Business Practice Location Address
First Line	:	1736 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-1904
Country	:	US
Telephone Number	:	313-382-7861
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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