Provider Demographics
NPI:1588289441
Name:KRAJACIC, DONNA RAE
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:RAE
Last Name:KRAJACIC
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 1:54711 CHICKASAW DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-2216
Mailing Address - Country:US
Mailing Address - Phone:586-322-8246
Mailing Address - Fax:
Practice Address - Street 1:54711 CHICKASAW DR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-2216
Practice Address - Country:US
Practice Address - Phone:586-322-8246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703110358164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse