Provider Demographics
NPI:1588097455
Name:SZYMANSKI, MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SZYMANSKI
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 1:38935 ANN ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-805-0488
Mailing Address - Fax:866-250-6385
Practice Address - Street 1:601 PARK ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1445
Practice Address - Country:US
Practice Address - Phone:570-253-8140
Practice Address - Fax:570-253-8633
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013048363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
12588288OtherCAQH