Provider Demographics
NPI:1851839526
Name:KRASNOSELSKY, ADAM KEITH (RN, BSN)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:KEITH
Last Name:KRASNOSELSKY
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2703 MARTIN LUTHER KING JR AVE SE
Mailing Address - Street 2:USCG BASE NCR HSWL MEDICAL CLINIC
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-7201
Mailing Address - Country:US
Mailing Address - Phone:202-372-4129
Mailing Address - Fax:
Practice Address - Street 1:2703 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:USCG BASE NCR HSWL MEDICAL CLINIC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-7201
Practice Address - Country:US
Practice Address - Phone:202-372-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704263550163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse