Provider Demographics
NPI:1184207680
Name:KRUKIEL, DAVID (PMHNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KRUKIEL
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2808 FOX CHASE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4008
Mailing Address - Country:US
Mailing Address - Phone:804-303-9622
Mailing Address - Fax:804-716-4318
Practice Address - Street 1:2201 LIBBIE AVE STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2364
Practice Address - Country:US
Practice Address - Phone:804-303-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001259386163WP0808X
VA0024181592363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health