Individual
JAN HAZEL PROKOSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNPC
Contact information
Practice address
1500 SANDPOINT RD, MUNISING, MI 49862-1406
(906) 387-4110
(906) 387-3514
Mailing address
1500 SANDPOINT RD, MUNISING, MI 49862-1406
(906) 387-4110
(906) 387-3514
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704215502
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5008770770
BLUE CROSS BLUE SHIELD
MI
Enumeration date
06/24/2006
Last updated
11/30/2012
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