Provider Demographics
NPI:1285612366
Name:SOCHACKI, JOYCE A (NP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:A
Last Name:SOCHACKI
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 1:44405 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5023
Mailing Address - Country:US
Mailing Address - Phone:248-858-3000
Mailing Address - Fax:
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:248-858-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704149783363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-4962898Medicaid
MI11-4938239Medicaid
MI10-4654192Medicaid
MI10-4654165Medicaid
MI10-4654183Medicaid
MI11-4938220Medicaid
MI11-4938257Medicaid
MI10-4962889Medicaid
MI11-4654174Medicaid
MI11-4938248Medicaid
MI10-4654147Medicaid
MI10-4654156Medicaid
MI11-4938220Medicaid
MI11-4938239Medicaid
MI11-4938257Medicaid
MIQ29944Medicare UPIN
P40010001Medicare PIN