1912304106 NPI number — MRS. MAGGIE KATHLEEN KRYWALSKI FNP

Table of content: MRS. MAGGIE KATHLEEN KRYWALSKI FNP (NPI 1912304106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912304106 NPI number — MRS. MAGGIE KATHLEEN KRYWALSKI FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRYWALSKI
Provider First Name:
MAGGIE
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
MAGGIE
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912304106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 IRVING AVE
Provider Second Line Business Mailing Address:
SUITE 1249
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13210-1718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-464-8986
Provider Business Mailing Address Fax Number:
315-464-2329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 IRVING AVE
Provider Second Line Business Practice Location Address:
SUITE 1249
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-464-8986
Provider Business Practice Location Address Fax Number:
315-464-2329
Provider Enumeration Date:
12/03/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SF0001X , with the licence number:  F338744-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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