Healthcare Provider Details

I. General information

NPI: 1447393590
Provider Name (Legal Business Name): SUSAN MARGARET BRATKOWSKI RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44199 DEQUINDRE RD SUITE 250
TROY MI
48085-1128
US

IV. Provider business mailing address

11954 ONTARIO DR
STERLING HEIGHTS MI
48313-1612
US

V. Phone/Fax

Practice location:
  • Phone: 248-879-8441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number4704163243
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: