Provider Demographics
NPI:1295711380
Name:PIZANIS, EILEEN MARIE (NP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:PIZANIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 634280
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-4280
Mailing Address - Country:US
Mailing Address - Phone:517-336-8080
Mailing Address - Fax:517-336-9122
Practice Address - Street 1:1215 E MICHIGAN
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48909
Practice Address - Country:US
Practice Address - Phone:517-364-2223
Practice Address - Fax:517-336-9122
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI119831164W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008766140OtherBCBS
MI5204943Medicaid
MI5204943Medicaid
MIN88180004Medicare PIN
MI5008766140OtherBCBS