Provider Demographics
NPI:1609062777
Name:STANISLOWSKI, RITA (RNC)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:STANISLOWSKI
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:MAY
Other - Last Name:SUCHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNC
Mailing Address - Street 1:6211 STATE RD
Mailing Address - Street 2:
Mailing Address - City:BURTCHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48059-2408
Mailing Address - Country:US
Mailing Address - Phone:810-385-3930
Mailing Address - Fax:
Practice Address - Street 1:3415 28TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6931
Practice Address - Country:US
Practice Address - Phone:810-987-5300
Practice Address - Fax:810-985-2150
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704083288163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory