Healthcare Provider Details

I. General information

NPI: 1851834865
Provider Name (Legal Business Name): KRYSTYNA SKOWRONSKI MS. RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22201 MOROSS RD SUITE 135
DETROIT MI
48236-2169
US

IV. Provider business mailing address

22201 MOROSS RD SUITE 135
DETROIT MI
48236-2169
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-7047
  • Fax:
Mailing address:
  • Phone: 313-343-7047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number001089897
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: