Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 4704299743 | MI |
N | 363L00000X | Nurse Practitioner | 71008589B | IN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704299743 | MI |
N | 363LP2300X | Nurse Practitioner - Primary Care | 71008589A | IN |
NPI | 1053803965 |
---|---|
Provider Name | Ms. Nadzieja Nicole Pocheki |
First Address | Dowagiac, MI 49047-1527 |
Second Address | Dowagiac, MI 49047-1527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2018 |
Last Update Date | 01/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
28213406A | INDIANA RN LICENSE (01) | IN |
44704299743 | MICHIGAN RN LICENSE WITH NURSE PRACTITIONER SPECIALTY (01) | MI |
71008589A | PRESCRIPTIVE AUTHORITY (01) | IN |
71008589B | CONTROLLED SUBSTANCE REGISTRATION (01) | IN |
MP4858304 | DEA (01) | |
MP5536303 | DEA (01) | MI |