Provider Demographics
NPI:1235701798
Name:BROCK, KATARZYNA NOELLE (NP)
Entity Type:Individual
Prefix:
First Name:KATARZYNA
Middle Name:NOELLE
Last Name:BROCK
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 1:40020 CAPITOL DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-5304
Mailing Address - Country:US
Mailing Address - Phone:586-335-5692
Mailing Address - Fax:
Practice Address - Street 1:19070 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-1449
Practice Address - Country:US
Practice Address - Phone:586-445-0177
Practice Address - Fax:585-773-1385
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704267940363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily