MEDICARE: MRS. HEATHER KRZYKOWSKI R.N.

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	163W00000X	Registered Nurse	138798	WI

General Provider Information

NPI Number	:	1629378187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER KRZYKOWSKI R.N.

Provider Business Mailing Address
First Line	:	4021 MAPLEDALE CT
Second Line	:
City	:	WISCONSIN RAPIDS
State	:	WI
Zip	:	54494-2708
Country	:	US
Telephone Number	:	715-424-3883
Fax Number	:

Provider Business Practice Location Address
First Line	:	4021 MAPLEDALE CT
Second Line	:
City	:	WISCONSIN RAPIDS
State	:	WI
Zip	:	54494-2708
Country	:	US
Telephone Number	:	715-424-3883
Fax Number	:

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

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	10/29/2010

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