Individual
MADALYN ROSE BACZKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, AGPCNP-BC
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 551-4400
Mailing address
26901 BEAUMONT BLVD, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704330114
MI
363LA2200X
Adult Health Nurse Practitioner
4704330114
MI
363LG0600X
Gerontology Nurse Practitioner
4704330114
MI
363LP2300X
Primary Care Nurse Practitioner
4704330114
MI
Other
Enumeration date
06/22/2023
Last updated
05/20/2025
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