MEDICARE: MS. KIMBERLY RACHEL WRZESINSKI

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	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1528754587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY RACHEL WRZESINSKI

Provider Business Mailing Address
First Line	:	56221 COUNTY ROAD 384
Second Line	:
City	:	GRAND JUNCTION
State	:	MI
Zip	:	49056-9753
Country	:	US
Telephone Number	:	269-434-6959
Fax Number	:	269-767-4973

Provider Business Practice Location Address
First Line	:	56221 COUNTY ROAD 384
Second Line	:
City	:	GRAND JUNCTION
State	:	MI
Zip	:	49056-9753
Country	:	US
Telephone Number	:	269-434-6959
Fax Number	:	269-767-4973

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

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	04/13/2023

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