Provider Demographics
NPI:1023746385
Name:WIERZGAC, ELLEN L (RN)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:WIERZGAC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24371 CATHERINE INDUSTRIAL DR STE 225
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2422
Mailing Address - Country:US
Mailing Address - Phone:248-675-9384
Mailing Address - Fax:248-869-6015
Practice Address - Street 1:24371 CATHERINE INDUSTRIAL DR STE 225
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2422
Practice Address - Country:US
Practice Address - Phone:248-675-9384
Practice Address - Fax:248-869-6015
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704173863163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management