Provider Demographics
NPI:1528692555
Name:AMCHESLAVSKY-REISIN, NATALIE (AFC)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:AMCHESLAVSKY-REISIN
Suffix:
Gender:F
Credentials:AFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35693 MORAVIAN DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2137
Mailing Address - Country:US
Mailing Address - Phone:248-633-3556
Mailing Address - Fax:586-408-6059
Practice Address - Street 1:35693 MORAVIAN DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-2137
Practice Address - Country:US
Practice Address - Phone:248-633-3556
Practice Address - Fax:586-408-6059
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS630318143310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility