Provider Demographics
NPI:1528754587
Name:WRZESINSKI, KIMBERLY RACHEL
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:RACHEL
Last Name:WRZESINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56221 COUNTY ROAD 384
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:MI
Mailing Address - Zip Code:49056-9753
Mailing Address - Country:US
Mailing Address - Phone:269-434-6959
Mailing Address - Fax:269-767-4973
Practice Address - Street 1:56221 COUNTY ROAD 384
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:MI
Practice Address - Zip Code:49056-9753
Practice Address - Country:US
Practice Address - Phone:269-434-6959
Practice Address - Fax:269-767-4973
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency