Provider Demographics
NPI:1114763471
Name:ZAKOSCIELNA, AGNIESZKA (NP)
Entity type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:ZAKOSCIELNA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44783 MARIGOLD DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1225
Mailing Address - Country:US
Mailing Address - Phone:248-635-5563
Mailing Address - Fax:
Practice Address - Street 1:44783 MARIGOLD DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1225
Practice Address - Country:US
Practice Address - Phone:248-635-5563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704316060363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner