Provider Demographics
NPI:1215735444
Name:MOZURKEWICH, ANNETTE
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:MOZURKEWICH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBUSH
Mailing Address - State:MI
Mailing Address - Zip Code:48878-9791
Mailing Address - Country:US
Mailing Address - Phone:989-317-7789
Mailing Address - Fax:
Practice Address - Street 1:600 E BROADWAY ST STE 110
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2776
Practice Address - Country:US
Practice Address - Phone:989-317-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501004987225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist