1528754587 NPI number — MS. KIMBERLY RACHEL WRZESINSKI

Table of content: MS. KIMBERLY RACHEL WRZESINSKI (NPI 1528754587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528754587 NPI number — MS. KIMBERLY RACHEL WRZESINSKI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WRZESINSKI
Provider First Name:
KIMBERLY
Provider Middle Name:
RACHEL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1528754587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
56221 COUNTY ROAD 384
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49056-9753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-434-6959
Provider Business Mailing Address Fax Number:
269-767-4973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56221 COUNTY ROAD 384
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49056-9753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-434-6959
Provider Business Practice Location Address Fax Number:
269-767-4973
Provider Enumeration Date:
04/13/2023

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: 253J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com