Provider Demographics
NPI:1619176740
Name:KRYPEL, MARLENE PEGGY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:PEGGY
Last Name:KRYPEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4988 CLIFTON PKWY
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5504
Mailing Address - Country:US
Mailing Address - Phone:716-627-3392
Mailing Address - Fax:
Practice Address - Street 1:4988 CLIFTON PKWY
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5504
Practice Address - Country:US
Practice Address - Phone:716-627-3392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113258-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02841454Medicaid