Healthcare Provider Details

I. General information

NPI: 1073243234
Provider Name (Legal Business Name): JORDAN T KRINSKY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 06/12/2022
Certification Date: 06/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 S COLUMBUS ST
ARLINGTON VA
22204-1350
US

IV. Provider business mailing address

134 S COLUMBUS ST
ARLINGTON VA
22204-1350
US

V. Phone/Fax

Practice location:
  • Phone: 847-337-5152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN1062408
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: