Provider Demographics
NPI:1760858674
Name:KORYZMA, KRYSTYNA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTYNA
Middle Name:
Last Name:KORYZMA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-0500
Mailing Address - Country:US
Mailing Address - Phone:716-699-9032
Mailing Address - Fax:716-699-9035
Practice Address - Street 1:5001 STATE HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-4508
Practice Address - Country:US
Practice Address - Phone:607-376-5346
Practice Address - Fax:607-376-5347
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342399363LF0000X
NJF07151355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty