Healthcare Provider Details

I. General information

NPI: 1003292855
Provider Name (Legal Business Name): NEENA LEE KOVALCHIK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EAST MICHIGAN AVENUE
LANSING MI
48912
US

IV. Provider business mailing address

6531 W. GRAND LEDGE HWY.
SUNFIELD MI
48890
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5137
  • Fax: 517-364-5997
Mailing address:
  • Phone: 517-214-4980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704239926
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: