MEDICARE: KRISTIN NICOLE KRUSZEWSKI PA-C

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	363A00000X	Physician Assistant	0010-03682	NC
2	363A00000X	Physician Assistant	5028	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619220746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN NICOLE KRUSZEWSKI PA-C

Provider Business Mailing Address
First Line	:	3371 W 32ND AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3101
Country	:	US
Telephone Number	:	727-967-6805
Fax Number	:

Provider Business Practice Location Address
First Line	:	3371 W 32ND AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-3101
Country	:	US
Telephone Number	:	727-967-6805
Fax Number	:

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

Provider Enumeration Date	:	10/26/2012
Last Update Date	:	11/25/2024

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