Provider Demographics
NPI:1083240147
Name:KRUPNIK, MARINA YANOVNA (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:YANOVNA
Last Name:KRUPNIK
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14412 W 139TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-8422
Mailing Address - Country:US
Mailing Address - Phone:913-244-1606
Mailing Address - Fax:
Practice Address - Street 1:14412 W 139TH TER
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-8422
Practice Address - Country:US
Practice Address - Phone:913-244-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS150461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse