Individual
MRS. SAMANTHA MICHELLE KACZMAREK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
888 W. BIG BEAVER RD. STE 900, TROY, MI 48084
(248) 629-2880
(248) 319-6493
Mailing address
888 W. BIG BEAVER RD. STE 900, TROY, MI 48084
(248) 629-2880
(248) 319-6493
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704311772
MI
363LF0000X
Family Nurse Practitioner
Primary
4704311772
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14589057
CAQH
MI
Enumeration date
12/03/2019
Last updated
11/02/2023
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