Healthcare Provider Details

I. General information

NPI: 1336836519
Provider Name (Legal Business Name): ARIEL JOCELYN ZUKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STODDARD RD
RICHMOND MI
48062-2505
US

IV. Provider business mailing address

19611 E 8 MILE RD
SAINT CLAIR SHORES MI
48080-1655
US

V. Phone/Fax

Practice location:
  • Phone: 586-541-9550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704383957
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: