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General NPI Number Information
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NPI Number | 1629024666
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Entity Type | Individual
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Provider Name | NANCY KOMINIAREK PA
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Gender | Female
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 02/03/2009
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Provider Practice Location Address
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Address Line | 25311 LITTLE MACK AVE SUITE B
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48081-3301
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Country | US
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Telephone | 586-498-2400
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Fax | 586-498-2800
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Provider Business Mailing Address
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Address Line | 25311 LITTLE MACK SUITE B
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City | ST. CLAIR SHORES
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State | MI
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Zip | 48081
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Country | US
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Telephone | 586-498-2400
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Fax | 586-498-2800
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601004536
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License Number State | MI
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