Provider Demographics
NPI:1467009134
Name:KRASIK, NADEZHDA (PA)
Entity Type:Individual
Prefix:
First Name:NADEZHDA
Middle Name:
Last Name:KRASIK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NADEZHDA
Other - Middle Name:
Other - Last Name:BREZHNEVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2598 BUCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7549
Mailing Address - Country:US
Mailing Address - Phone:248-797-0662
Mailing Address - Fax:
Practice Address - Street 1:2891 E MAPLE RD # 102S-102
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-6106
Practice Address - Country:US
Practice Address - Phone:485-249-0852
Practice Address - Fax:248-524-9086
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant