Provider Demographics
NPI:1396753778
Name:SZCZERBA, MARY CAROL (MSN, NP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CAROL
Last Name:SZCZERBA
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CAROL
Other - Last Name:STEFFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, NP
Mailing Address - Street 1:15400 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3491
Mailing Address - Country:US
Mailing Address - Phone:313-584-3359
Mailing Address - Fax:313-584-1729
Practice Address - Street 1:15400 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3491
Practice Address - Country:US
Practice Address - Phone:313-584-3359
Practice Address - Fax:313-584-1729
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704112158363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health