Healthcare Provider Details

I. General information

NPI: 1639718810
Provider Name (Legal Business Name): MICHELLE LYNNE KRENZKE ATC, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2020
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2950
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2950
US

V. Phone/Fax

Practice location:
  • Phone: 301-956-4821
  • Fax:
Mailing address:
  • Phone: 301-956-4821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0010010
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA0001118
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: