Provider Demographics
NPI:1730431099
Name:SOKOLOVA, VESNA (NP)
Entity type:Individual
Prefix:
First Name:VESNA
Middle Name:
Last Name:SOKOLOVA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VESNA
Other - Middle Name:
Other - Last Name:BOGGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:17141 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-1112
Mailing Address - Country:US
Mailing Address - Phone:313-369-1717
Mailing Address - Fax:313-369-1728
Practice Address - Street 1:21700 GREENFIELD RD STE 203
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2879
Practice Address - Country:US
Practice Address - Phone:248-967-0115
Practice Address - Fax:313-369-1728
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704295293163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty