Healthcare Provider Details

I. General information

NPI: 1386433399
Provider Name (Legal Business Name): KRISHNA MRAKOVCIC MSCN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 BISHOP RD
GROSSE POINTE PARK MI
48230-1422
US

IV. Provider business mailing address

1175 BISHOP RD
GROSSE POINTE PARK MI
48230-1422
US

V. Phone/Fax

Practice location:
  • Phone: 970-426-8834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: