Provider Demographics
NPI:1578710166
Name:CHURCH, CAROL LOUISE (JD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LOUISE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:JD
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:CHURCH
Other - Last Name:BRUDZYNSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:47699 EDINBOROUGH LN
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-3458
Mailing Address - Country:US
Mailing Address - Phone:248-347-2726
Mailing Address - Fax:
Practice Address - Street 1:47699 EDINBOROUGH LN
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-3458
Practice Address - Country:US
Practice Address - Phone:248-347-2726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program