Basic Information
Provider Information
NPI: 1619468154
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MLYNARCZYK
FirstName: ANNA
MiddleName: MARIA
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SCHUERNER
OtherFirstName: ANNA
OtherMiddleName: MARIA
OtherNamePrefix: MRS.
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 2
Mailing Information
Address1: 1611 NW 12TH AVE, JACKSON MEMORIAL HOSPITAL, CRITICAL C
Address2:  
City: MIAMI
State: FL
PostalCode: 33136
CountryCode: US
TelephoneNumber: 3055851191
FaxNumber:  
Practice Location
Address1: 1611 NW 12TH AVE, JACKSON MEMORIAL HOSPITAL, CRITICAL C
Address2:  
City: MIAMI
State: FL
PostalCode: 33136
CountryCode: US
TelephoneNumber: 3055851191
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/21/2018
LastUpdateDate: 05/21/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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