Provider Demographics
NPI:1639718810
Name:KRENZKE, MICHELLE LYNNE (ATC, PA-S2)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LYNNE
Last Name:KRENZKE
Suffix:
Gender:F
Credentials:ATC, PA-S2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 W FAYETTE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1756
Mailing Address - Country:US
Mailing Address - Phone:301-956-4821
Mailing Address - Fax:
Practice Address - Street 1:520 W FAYETTE ST STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1756
Practice Address - Country:US
Practice Address - Phone:301-956-4821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-05
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00011182255A2300X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer