Healthcare Provider Details

I. General information

NPI: 1609062777
Provider Name (Legal Business Name): RITA STANISLOWSKI RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RITA MAY SUCHIN RNC

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 28TH ST
PORT HURON MI
48060-6931
US

IV. Provider business mailing address

6211 STATE RD
BURTCHVILLE MI
48059-2408
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-5300
  • Fax: 810-985-2150
Mailing address:
  • Phone: 810-385-3930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number4704083288
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: