Individual
MRS. ALICIA ANNE PRUCKNIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN, CCM
Contact information
Practice address
23772 WEST RD # 262, BROWNSTOWN TWP, MI 48183-3050
(734) 788-9111
(734) 941-3264
Mailing address
23772 WEST RD # 262, BROWNSTOWN TWP, MI 48183-3050
(734) 788-9111
(734) 941-3264
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
4704244622
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704244622
MI
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
4704244622
MI
Other
Enumeration date
08/10/2021
Last updated
02/13/2025
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