Basic Information
| Provider Information | |||||||||
| NPI: | 1003292855 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOVALCHIK | ||||||||
| FirstName: | NEENA | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6531 W. GRAND LEDGE HWY. | ||||||||
| Address2: | |||||||||
| City: | SUNFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172144980 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 EAST MICHIGAN AVENUE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173645137 | ||||||||
| FaxNumber: | 5173645997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2015 | ||||||||
| LastUpdateDate: | 08/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 4704239926 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.