Provider Demographics
NPI:1003816414
Name:PILZNINSKI, CAROLYN (NP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:PILZNINSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3744 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3512
Mailing Address - Country:US
Mailing Address - Phone:313-561-8749
Mailing Address - Fax:
Practice Address - Street 1:19135 ALLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-6813
Practice Address - Country:US
Practice Address - Phone:734-362-9032
Practice Address - Fax:734-362-9001
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704103731363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1184655755OtherGP NPI
MI5008666170OtherBCBSM
MI1184655755OtherGP NPI