Provider Demographics
NPI:1699511717
Name:MICHALIK, IZABELLA EDYTA (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:IZABELLA
Middle Name:EDYTA
Last Name:MICHALIK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37654 MYRNA ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1419
Mailing Address - Country:US
Mailing Address - Phone:313-433-1514
Mailing Address - Fax:
Practice Address - Street 1:37654 MYRNA ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1419
Practice Address - Country:US
Practice Address - Phone:313-433-1514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704321833363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health