MEDICARE: RENEE KRACZEK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	191279-3102	UT

General Provider Information

NPI Number	:	1336937234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE KRACZEK

Provider Business Mailing Address
First Line	:	PO BOX 827
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-0827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 S MAIN ST
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-6719
Country	:	US
Telephone Number	:	435-239-8768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2025
Last Update Date	:	04/29/2025

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Directions to “ RENEE KRACZEK ” Practice Location

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