Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704103731 | MI |
N | 363LA2100X | Nurse Practitioner - Acute Care | 4704103731 | MI |
NPI | 1003816414 |
---|---|
Provider Name | Carolyn Pilzninski |
First Address | Dearborn, MI 48124-3512 |
Second Address | Brownstown Twp, MI 48183-6813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 08/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1184655755 | GP NPI (01) | MI |
5008666170 | BCBSM (01) | MI |