MEDICARE: MRS. EDEN KREJCI FNP-BC

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	363LF0000X	Family Nurse Practitioner	APRN.CNP.0033051	OH
2	363LF0000X	Family Nurse Practitioner	2022045055	MO
3	363LF0000X	Family Nurse Practitioner	71013543A	IN
4	363LF0000X	Family Nurse Practitioner	209.028203	IL
5	363LF0000X	Family Nurse Practitioner	8633-33	WI

General Provider Information

NPI Number	:	1548741135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EDEN KREJCI FNP-BC

Provider Business Mailing Address
First Line	:	1408 ADELE CT
Second Line	:
City	:	GRAFTON
State	:	WI
Zip	:	53024-2824
Country	:	US
Telephone Number	:	573-270-9017
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 S 84TH ST STE 400
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1469
Country	:	US
Telephone Number	:	573-270-9017
Fax Number	:

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

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	03/01/2026

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