Healthcare Provider Details

I. General information

NPI: 1053799353
Provider Name (Legal Business Name): ANNA S KRAPIVINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MATTHEW DR
WAYNESBORO MS
39367-2567
US

IV. Provider business mailing address

PO BOX PH
CHINLE AZ
86503-8000
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-7285
  • Fax:
Mailing address:
  • Phone: 928-674-7001
  • Fax: 928-674-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberT7623
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: