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General NPI Number Information
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NPI Number | 1366595217
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Entity Type | Individual
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Provider Name | KATHLEEN MARIE PAWLIK CPNP
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3901 BEAUBIEN ST PEDIATRIC NEUROLOGY
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City | DETROIT
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State | MI
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Zip | 48201-2119
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Country | US
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Telephone | 313-933-8565
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Fax | 313-745-5788
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Provider Business Mailing Address
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Address Line | 15137 VINO ROSA CT
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-4441
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Country | US
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Telephone | 586-977-0153
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 4704091264
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License Number State | MI
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