Provider Demographics
NPI:1740544204
Name:BARDZILOWSKI, EDITH ANN (NNP-BC, MSN)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:ANN
Last Name:BARDZILOWSKI
Suffix:
Gender:F
Credentials:NNP-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7393 N SEYMOUR RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-9265
Mailing Address - Country:US
Mailing Address - Phone:810-659-5161
Mailing Address - Fax:
Practice Address - Street 1:7393 N SEYMOUR RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-9265
Practice Address - Country:US
Practice Address - Phone:810-659-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704164249363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal