Healthcare Provider Details

I. General information

NPI: 1023204765
Provider Name (Legal Business Name): DOROTHY SUSAN PIOSZAK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/27/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 M 32 W
ALPENA MI
49707-1499
US

IV. Provider business mailing address

16341 PINE ST
PRESQUE ISLE MI
49777-8652
US

V. Phone/Fax

Practice location:
  • Phone: 989-354-9830
  • Fax:
Mailing address:
  • Phone: 810-513-4126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704172619
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number4704172619
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: