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General NPI Number Information
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NPI Number | 1235701798
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Entity Type | Individual
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Provider Name | KATARZYNA NOELLE BROCK NP
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Gender | Female
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 19070 E 10 MILE RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-1449
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Country | US
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Telephone | 586-445-0177
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Fax | 585-773-1385
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Provider Business Mailing Address
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Address Line | 40020 CAPITOL DR
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City | STERLING HEIGHTS
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State | MI
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Zip | 48313-5304
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Country | US
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Telephone | 586-335-5692
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704267940
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704267940
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License Number State | MI
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