Healthcare Provider Details

I. General information

NPI: 1851839526
Provider Name (Legal Business Name): ADAM KEITH KRASNOSELSKY RN, BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 MARTIN LUTHER KING JR AVE SE USCG BASE NCR HSWL MEDICAL CLINIC
WASHINGTON DC
20593-7201
US

IV. Provider business mailing address

2703 MARTIN LUTHER KING JR AVE SE USCG BASE NCR HSWL MEDICAL CLINIC
WASHINGTON DC
20593-7201
US

V. Phone/Fax

Practice location:
  • Phone: 202-372-4129
  • Fax:
Mailing address:
  • Phone: 202-372-4129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704263550
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: