Provider Demographics
NPI:1568581148
Name:SZYNKOWSKI, ELIZABETH J (RD, LD, PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:SZYNKOWSKI
Suffix:
Gender:F
Credentials:RD, LD, PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:J
Other - Last Name:THOMPSON
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:901 KIMOLE LN
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1491
Mailing Address - Country:US
Mailing Address - Phone:517-263-6140
Mailing Address - Fax:517-265-5876
Practice Address - Street 1:901 KIMOLE LN
Practice Address - Street 2:SUITE A-4
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1491
Practice Address - Country:US
Practice Address - Phone:517-263-6140
Practice Address - Fax:517-265-5876
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 5783133V00000X
MI5601005709363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered