Provider Demographics
NPI:1801493747
Name:MOZURKEWICH, ERIC D (NP-C, RN)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:MOZURKEWICH
Suffix:
Gender:M
Credentials:NP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18463 LIVERNOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2254
Mailing Address - Country:US
Mailing Address - Phone:313-861-4400
Mailing Address - Fax:
Practice Address - Street 1:18463 LIVERNOIS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2254
Practice Address - Country:US
Practice Address - Phone:313-861-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704286616363LF0000X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency