1467009134 NPI number — NADEZHDA KRASIK PA

Table of content: JENNIFER ASHLEY NELSON PT, DPT (NPI 1417325531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467009134 NPI number — NADEZHDA KRASIK PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRASIK
Provider First Name:
NADEZHDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BREZHNEVA
Provider Other First Name:
NADEZHDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1467009134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2598 BUCKINGHAM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48009-7549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-797-0662
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2891 E MAPLE RD # 102S-102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48083-6106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
485-249-0852
Provider Business Practice Location Address Fax Number:
248-524-9086
Provider Enumeration Date:
08/19/2019

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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