| Doctor Name: | MRS. NEENA LEE KOVALCHIK |
| NPI Number: | 1003292855 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 4704239926 |
| Business Practice Address: | 1200 East Michigan Avenue Lansing, MI - 48912 |
| Business Phone Number: | 5173645137 |
| Business Fax Number: | 5173645997 |
| Mailing Address: | 6531 W. Grand Ledge Hwy., SUNFIELD |
| State: | MI |
| Postal Code: | 48890 |
| Phone Number: | 5172144980 |
| Fax Number: | |
| NPI Enumeration Date: | 08/04/2015 |
| NPI Last Update Date: | 08/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 4704239926 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |