Provider Demographics
NPI:1225046394
Name:POKRIEFKA, MARINA VICINI (CNS)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:VICINI
Last Name:POKRIEFKA
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:MISS
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:VICINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:12850 FOUNTAIN SQ
Mailing Address - Street 2:STE. 106
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-2552
Mailing Address - Country:US
Mailing Address - Phone:248-634-6303
Mailing Address - Fax:248-634-1746
Practice Address - Street 1:12850 FOUNTAIN SQ
Practice Address - Street 2:STE. 106
Practice Address - City:DAVISBURG
Practice Address - State:MI
Practice Address - Zip Code:48350-2552
Practice Address - Country:US
Practice Address - Phone:248-634-6303
Practice Address - Fax:248-634-1746
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704115134364SP0807X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult