Healthcare Provider Details

I. General information

NPI: 1952607731
Provider Name (Legal Business Name): JANET R PUZYCKI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 M-139
BENTON HARBOR MI
49022-4843
US

IV. Provider business mailing address

50 INDUSTRIAL PARK RD
BANGOR MI
49013-1246
US

V. Phone/Fax

Practice location:
  • Phone: 269-927-5400
  • Fax: 269-927-5493
Mailing address:
  • Phone: 269-427-7937
  • Fax: 269-427-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704200577
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: