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NPI Code Detail

MEDICARE: DR. KRYSTAL NICOLE YANKOWSKI D.O.

MEDICARE: DR. KRYSTAL NICOLE YANKOWSKI D.O.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2208100000XPhysical Medicine & Rehabilitation PhysicianDO83528SC

General Provider Information

NPI Number : 1760916621
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRYSTAL NICOLE YANKOWSKI D.O.
Provider Business Mailing Address
First Line : 340 W POINTE DR
Second Line :
City : SPARTANBURG
State : SC
Zip : 29301-3401
Country : US
Telephone Number : 561-789-2662
Fax Number :
Provider Business Practice Location Address
First Line : 3372 LAURENS RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-5236
Country : US
Telephone Number : 864-537-4600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2017
Last Update Date : 08/17/2021

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