Provider Demographics
NPI:1790482198
Name:KRYVCHENKO, ULYANA (NP)
Entity Type:Individual
Prefix:
First Name:ULYANA
Middle Name:
Last Name:KRYVCHENKO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ULYANA
Other - Middle Name:
Other - Last Name:PYSARENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2649 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4714
Mailing Address - Country:US
Mailing Address - Phone:248-643-0044
Mailing Address - Fax:
Practice Address - Street 1:2649 CROOKS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4714
Practice Address - Country:US
Practice Address - Phone:248-643-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704296845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily