Healthcare Provider Details

I. General information

NPI: 1669896718
Provider Name (Legal Business Name): KRISTI ZYLLA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41521 W 11 MILE RD
NOVI MI
48375-1803
US

IV. Provider business mailing address

7661 KOLB AVE
ALLEN PARK MI
48101-2219
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-0030
  • Fax:
Mailing address:
  • Phone: 734-497-0255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704293380
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: