Provider Demographics
NPI:1376052977
Name:MALINOWSKI, CHRISTINE (DNP, RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:MALINOWSKI
Suffix:
Gender:F
Credentials:DNP, RN, FNP-BC
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:LAZUKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17197 N LAUREL PARK DR STE 107
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-7910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 EUREKA RD STE B
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5839
Practice Address - Country:US
Practice Address - Phone:734-225-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704299176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704299176OtherLICENSE