Provider Demographics
NPI:1417178567
Name:KRAYNAK, ROSEANN LILLIAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:ROSEANN
Middle Name:LILLIAN
Last Name:KRAYNAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ROSEANN
Other - Middle Name:LILIAN
Other - Last Name:MCMENEMY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:496 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7207
Mailing Address - Country:US
Mailing Address - Phone:978-373-3193
Mailing Address - Fax:
Practice Address - Street 1:496 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-7207
Practice Address - Country:US
Practice Address - Phone:978-373-3193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA109870163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse