Provider Demographics
NPI:1407205719
Name:PAKULSKI, NORMA (LMT, LPN)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:PAKULSKI
Suffix:
Gender:F
Credentials:LMT, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 STONE ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3569
Mailing Address - Country:US
Mailing Address - Phone:810-488-5833
Mailing Address - Fax:
Practice Address - Street 1:1107 STONE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3569
Practice Address - Country:US
Practice Address - Phone:810-488-5833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703109798164W00000X
MI7501007800225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No164W00000XNursing Service ProvidersLicensed Practical Nurse