Healthcare Provider Details

I. General information

NPI: 1063220697
Provider Name (Legal Business Name): MS. NICOLE BOROWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2024
Last Update Date: 12/30/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2532 24 MILE RD
SHELBY TOWNSHIP MI
48316-2762
US

IV. Provider business mailing address

2532 24 MILE RD
SHELBY TOWNSHIP MI
48316-2762
US

V. Phone/Fax

Practice location:
  • Phone: 586-339-2178
  • Fax:
Mailing address:
  • Phone: 586-339-2178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: