Individual
JACLYN M STOCKOSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 898-7784
Mailing address
130 TOWN CENTER DR STE 203, BEAUMONT PHYSICIAN PARTNERS PAYOR ENROLLMENT, TROY, MI 48084-1744
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704253212
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1093019747
—
MI
01
—
430F364420
BCBSM
MI
Enumeration date
01/10/2011
Last updated
02/09/2017
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