1396753778 NPI number — MS. MARY CAROL SZCZERBA MSN, NP

Table of content: MS. MARY CAROL SZCZERBA MSN, NP (NPI 1396753778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396753778 NPI number — MS. MARY CAROL SZCZERBA MSN, NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SZCZERBA
Provider First Name:
MARY
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEFFEN
Provider Other First Name:
MARY
Provider Other Middle Name:
CAROL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396753778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15400 MICHIGAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEARBORN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48126-3491
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-584-3359
Provider Business Mailing Address Fax Number:
313-584-1729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15400 MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48126-3491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-584-3359
Provider Business Practice Location Address Fax Number:
313-584-1729
Provider Enumeration Date:
08/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  4704112158 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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