MEDICARE: CHRISTOPHER KRUSNIAK RN

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	163WM0705X	Medical-Surgical Registered Nurse	9563799	FL

General Provider Information

NPI Number	:	1922673060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER KRUSNIAK RN

Provider Business Mailing Address
First Line	:	1800 N ESTRELLA CT APT 202
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410-4981
Country	:	US
Telephone Number	:	616-558-5780
Fax Number	:

Provider Business Practice Location Address
First Line	:	5555 W BLUE HERON BLVD
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33418-7815
Country	:	US
Telephone Number	:	561-840-0754
Fax Number	:

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

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	05/21/2021

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