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Individual
MRS. MICHELLE PRUNKARD-CZERW
Active
Individual
MRS. MICHELLE PRUNKARD-CZERW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004707
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0652512000
BCBS IND PIN
MI
01
—
MP004707
STATE LICENSE
MI
Enumeration date
12/29/2006
Last updated
07/19/2022
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