Provider Demographics
NPI:1992919690
Name:POKORNICKI, NONIE M (MSN, APRN, BC)
Entity type:Individual
Prefix:MS
First Name:NONIE
Middle Name:M
Last Name:POKORNICKI
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W. BIG BEAVER RD
Mailing Address - Street 2:SUITE 1060
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4100
Mailing Address - Country:US
Mailing Address - Phone:248-457-9190
Mailing Address - Fax:248-457-9188
Practice Address - Street 1:201 W. BIG BEAVER RD
Practice Address - Street 2:SUITE 1060
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4100
Practice Address - Country:US
Practice Address - Phone:248-457-9190
Practice Address - Fax:248-457-9188
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704207540363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008652220OtherBLUE CROSS BLUE SHIELD
MI104740595Medicaid
MI104740595Medicaid
MI5008652220OtherBLUE CROSS BLUE SHIELD