Basic Information
| Provider Information | |||||||||
| NPI: | 1568790244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRZYS | ||||||||
| FirstName: | TIMOTHY | ||||||||
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| Credential: | MSN, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2111 MERRITT RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488236916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173324263 | ||||||||
| FaxNumber: | 5173321132 | ||||||||
| Practice Location | |||||||||
| Address1: | 2111 MERRITT RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488236916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173324263 | ||||||||
| FaxNumber: | 5173321132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2009 | ||||||||
| LastUpdateDate: | 11/18/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SA2200X | 4704131359 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.