Alicia Haley Petrunak

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

4704330124 Issued in MI

Practice address

2799 W Grand Blvd
Detroit, MI 48202-2689

Phone

(313) 916-2600

NPI assigned

Oct 15, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1487296091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3671 BUCKINGHAM AVE",
            "city": "BERKLEY",
            "state": "MI",
            "postal_code": "480721464",
            "telephone_number": "586-612-8817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022689",
            "telephone_number": "313-916-2600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3671 Buckingham Ave",
            "address_purpose": "LOCATION",
            "city": "Berkley",
            "state": "MI",
            "postal_code": "480721464",
            "country_code": "US",
            "telephone_number": "586-612-8817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRUNAK",
        "first_name": "ALICIA",
        "middle_name": "HALEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-15",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704330124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pcerecords.essmichigan@direct.mihin.net",
            "affiliation": "Y",
            "affiliationName": "Easterseals MORC Health Care, Inc.",
            "address_1": "2399 E Walton Blvd",
            "city": "Auburn Hills",
            "state": "MI",
            "country_code": "US",
            "postal_code": "483261955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anthony Petrillo, MD
• Christy A Petroff, MD
• Labina Petrovska, MD
• Samantha Rose Petrovski
• Louise Fraser Petrucci, RN
• Justin David Petrusak, LMSW
• John Paul Petrykowski, DO
• Robert Pettaway
• Jimeka Pettes, MD
• Shania Petticord

• Registered Nurse in Detroit, MI
• Providers in Detroit, MI by specialty
• Registered Nurse in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.