Healthcare Provider Details

I. General information

NPI: 1487290045
Provider Name (Legal Business Name): ALICJA SZEWCZYK NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28300 FRANKLIN RD
SOUTHFIELD MI
48034-1657
US

IV. Provider business mailing address

375 GRONDIN AVE
LASALLE ONTARIO
N9J3R2
CA

V. Phone/Fax

Practice location:
  • Phone: 248-353-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704242806
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: