Provider Demographics
NPI:1972859965
Name:KRAJESKI, MELISSA (LAC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:KRAJESKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 PROSPECTOR AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7480
Mailing Address - Country:US
Mailing Address - Phone:435-659-9464
Mailing Address - Fax:
Practice Address - Street 1:1816 PROSPECTOR AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7480
Practice Address - Country:US
Practice Address - Phone:435-659-9464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6734651-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist