Healthcare Provider Details

I. General information

NPI: 1851851224
Provider Name (Legal Business Name): ELBERTA DZIOBAK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST
DETROIT MI
48201-2018
US

IV. Provider business mailing address

3990 JOHN R ST
DETROIT MI
48201-2018
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-3456
  • Fax: 313-993-4100
Mailing address:
  • Phone: 313-993-3456
  • Fax: 313-993-4100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704248684
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: