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General NPI Number Information
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NPI Number | 1912504978
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Entity Type | Individual
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Provider Name | MARY MARGARET KRZYSTOWCZYK NP
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Gender | Female
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 930 N LOGAN ST APT 1/2
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City | DENVER
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State | CO
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Zip | 80203-3193
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Country | US
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Telephone | 248-404-8867
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Fax |
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Provider Business Mailing Address
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Address Line | 524 W THIRTEENTH ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4014
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Country | US
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Telephone | 248-404-8867
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AG01200132
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704301134
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | AG01200132
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License Number State | CO
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