Provider Demographics
NPI:1912359837
Name:VUKTILAJ, NORA (NP)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:VUKTILAJ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NORA
Other - Middle Name:
Other - Last Name:GOJCAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3601 W 13 MILE RD STE EC
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-898-0575
Practice Address - Fax:248-898-4671
Is Sole Proprietor?:No
Enumeration Date:2016-07-02
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN03303363L00000X
NY351517363L00000X
OHAPRN.CNP.0032287363L00000X
MI4704280648363L00000X, 363LF0000X
CT196443363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily