Provider Demographics
NPI:1184881997
Name:WOJDULA, LISA JEAN (ND, FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:WOJDULA
Suffix:
Gender:F
Credentials:ND, FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:JEAN
Other - Last Name:HUEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-0000
Mailing Address - Fax:
Practice Address - Street 1:600 N MAIN ST STE 210
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1152
Practice Address - Country:US
Practice Address - Phone:989-652-1440
Practice Address - Fax:989-652-1430
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704215979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN170690KMedicare UPIN