Healthcare Provider Details

I. General information

NPI: 1780203125
Provider Name (Legal Business Name): LINDA M KRZEMEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 BLUE STAR HWY
SOUTH HAVEN MI
49090-7758
US

IV. Provider business mailing address

00500 62ND. ST
SOUTH HAVEN MI
49090
US

V. Phone/Fax

Practice location:
  • Phone: 269-637-1115
  • Fax: 269-639-1314
Mailing address:
  • Phone: 269-910-5466
  • Fax: 269-639-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number4704129358
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: