Healthcare Provider Details

I. General information

NPI: 1710385620
Provider Name (Legal Business Name): RENEE KATHERINE SOKOLOWSKI CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6777 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

1428 S LAPEER RD
LAKE ORION MI
48360-1437
US

V. Phone/Fax

Practice location:
  • Phone: 800-653-6568
  • Fax: 313-876-1305
Mailing address:
  • Phone: 248-693-2697
  • Fax: 248-630-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number4704266687
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704266687
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: