1508122888 NPI number — MS. REBECCA CARRIE MICHELE KRYSZKIEWICZ LSW

Table of content: MS. REBECCA CARRIE MICHELE KRYSZKIEWICZ LSW (NPI 1508122888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508122888 NPI number — MS. REBECCA CARRIE MICHELE KRYSZKIEWICZ LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRYSZKIEWICZ
Provider First Name:
REBECCA
Provider Middle Name:
CARRIE MICHELE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1508122888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BUILDING 673
Provider Second Line Business Mailing Address:
STOP 129
Provider Business Mailing Address City Name:
SCHOFIELD BARRACKS
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96857-5000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-433-9011
Provider Business Mailing Address Fax Number:
808-433-8701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BUILDING 673
Provider Second Line Business Practice Location Address:
STOP 129
Provider Business Practice Location Address City Name:
SCHOFIELD BARRACKS
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96857-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-9011
Provider Business Practice Location Address Fax Number:
808-433-8701
Provider Enumeration Date:
04/11/2012

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: 104100000X , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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