Provider Demographics
NPI:1578834917
Name:SAWKA, KATHERINA LUBA (NP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINA
Middle Name:LUBA
Last Name:SAWKA
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:MISS
Other - First Name:KATHERINA
Other - Middle Name:LUBA
Other - Last Name:MANKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:21701 W 11 MILE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3713
Mailing Address - Country:US
Mailing Address - Phone:248-207-1297
Mailing Address - Fax:
Practice Address - Street 1:21701 WEST 11 MILE ROAD, SUITE #4
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076
Practice Address - Country:US
Practice Address - Phone:248-355-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704235399163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1578834917Medicaid