Provider Demographics
NPI:1215266226
Name:MCRUIZ, MICHELLE KUZNICKI (PA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:KUZNICKI
Last Name:MCRUIZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:24 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6099
Mailing Address - Country:US
Mailing Address - Phone:203-739-6959
Mailing Address - Fax:203-739-6495
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6099
Practice Address - Country:US
Practice Address - Phone:203-739-6959
Practice Address - Fax:203-739-6495
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002357363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical