Provider Demographics
NPI:1396837936
Name:POKORSKI, MARJORIE J (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:J
Last Name:POKORSKI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 LUDINGTON ST
Mailing Address - Street 2:WIC SUITE 100
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-4212
Mailing Address - Country:US
Mailing Address - Phone:906-786-5707
Mailing Address - Fax:906-789-4406
Practice Address - Street 1:3409 LUDINGTON ST
Practice Address - Street 2:WIC SUITE 100
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-4212
Practice Address - Country:US
Practice Address - Phone:906-786-5707
Practice Address - Fax:906-789-4406
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI096352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4967633Medicaid
P00187676OtherRAILROAD MEDICARE
MI5008764870OtherBLUE CROSS BLUE SHIELD
P00187676OtherRAILROAD MEDICARE
MI0N24730Medicare PIN