MEDICARE: BOBBIE KRZYWOZYCKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	4704161840	MI

General Provider Information

NPI Number	:	1538450812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBIE KRZYWOZYCKI

Provider Business Mailing Address
First Line	:	4800 BEMIS RD
Second Line	:
City	:	YPSILANTI
State	:	MI
Zip	:	48197-9375
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2770 CARPENTER RD
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48108-4104
Country	:	US
Telephone Number	:	734-971-6300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	04/21/2011

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