Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 26NJ00314000 | NJ |
NPI | 1013556067 |
---|---|
Provider Name | Irene Krawczyk |
First Address | Hackensack, NJ 07601-1915 |
Second Address | Hackensack, NJ 07601-1915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2019 |
Last Update Date | 21/12/2019 |