Healthcare Provider Details

I. General information

NPI: 1568790244
Provider Name (Legal Business Name): TIMOTHY KRZYS MSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 MERRITT RD SUITE 101
EAST LANSING MI
48823-6916
US

IV. Provider business mailing address

2111 MERRITT RD SUITE 101
EAST LANSING MI
48823-6916
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-4263
  • Fax: 517-332-1132
Mailing address:
  • Phone: 517-332-4263
  • Fax: 517-332-1132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number4704131359
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: