Provider Demographics
NPI:1568627750
Name:KRYZHANOVSKY, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:KRYZHANOVSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16478 BEACH BLVD
Mailing Address - Street 2:#145
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7860
Mailing Address - Country:US
Mailing Address - Phone:714-605-4367
Mailing Address - Fax:
Practice Address - Street 1:1921 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3230
Practice Address - Country:US
Practice Address - Phone:714-605-4367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide