Provider Demographics
NPI:1578940565
Name:KRCMARIK, ANN (NP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:
Last Name:KRCMARIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27101 SCHOENHERR RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4730
Mailing Address - Country:US
Mailing Address - Phone:586-758-5800
Mailing Address - Fax:586-758-7442
Practice Address - Street 1:27101 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4730
Practice Address - Country:US
Practice Address - Phone:586-758-5800
Practice Address - Fax:586-758-7442
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234969363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology