Individual
MICHELLE MARIE FODCZUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4926 N ISLAND DR E, BONNEY LAKE, WA 98391-8608
(425) 365-6968
(425) 386-5065
Mailing address
4926 N ISLAND DR E, BONNEY LAKE, WA 98391-8608
(425) 365-6968
(425) 365-5065
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
RN0119006
WA
Other
Enumeration date
04/05/2023
Last updated
04/05/2023
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