Provider Demographics
NPI:1073896015
Name:KROTKIEWICZ, DOROTA A
Entity Type:Individual
Prefix:
First Name:DOROTA
Middle Name:A
Last Name:KROTKIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 LAS PALMAS LN APT 222
Mailing Address - Street 2:
Mailing Address - City:LAUGHLIN
Mailing Address - State:NV
Mailing Address - Zip Code:89029-1224
Mailing Address - Country:US
Mailing Address - Phone:702-299-7246
Mailing Address - Fax:
Practice Address - Street 1:6655 W SAHARA AVE # B200-129
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0842
Practice Address - Country:US
Practice Address - Phone:702-365-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst