Provider Demographics
NPI:1437316908
Name:KRZNARICH, MELANIE RENAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:RENAE
Last Name:KRZNARICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 BENDING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-3012
Mailing Address - Country:US
Mailing Address - Phone:810-659-4723
Mailing Address - Fax:
Practice Address - Street 1:3244 BENDING BROOK DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-3012
Practice Address - Country:US
Practice Address - Phone:810-659-4723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002542363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant