Provider Demographics
NPI:1033790886
Name:KRISHNAMURTHY, VIDYA (RN)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:KRISHNAMURTHY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 EVERETT DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5066
Mailing Address - Country:US
Mailing Address - Phone:248-736-4729
Mailing Address - Fax:
Practice Address - Street 1:43034 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1722
Practice Address - Country:US
Practice Address - Phone:586-254-1021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704326818163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse