Basic Information
Provider Information
NPI: 1578207965
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOLUBOWSKI
FirstName: MONIKA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 40373 PRITTS CT
Address2:  
City: CLINTON TOWNSHIP
State: MI
PostalCode: 480384134
CountryCode: US
TelephoneNumber: 3133034667
FaxNumber:  
Practice Location
Address1: 3601 W 13 MILE RD
Address2:  
City: ROYAL OAK
State: MI
PostalCode: 480736712
CountryCode: US
TelephoneNumber: 2488985000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/22/2022
LastUpdateDate: 04/22/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/22/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X4704307106MIY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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