Provider Demographics
NPI:1154806354
Name:LACKOWSKI, LINDA ROSE (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:ROSE
Last Name:LACKOWSKI
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70570 ELDRED RD
Mailing Address - Street 2:
Mailing Address - City:BRUCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48065-4230
Mailing Address - Country:US
Mailing Address - Phone:586-850-8254
Mailing Address - Fax:
Practice Address - Street 1:27070 HOOVER RD STE A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-4591
Practice Address - Country:US
Practice Address - Phone:586-573-9090
Practice Address - Fax:586-573-2128
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704310801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily