Provider Demographics
NPI:1588348049
Name:KURYLO, ELIZABETH ROSE (CHW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROSE
Last Name:KURYLO
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:LIZZY
Other - Middle Name:ROSE
Other - Last Name:KURYLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHW, EMT-BASIC
Mailing Address - Street 1:1010 E WEST MAPLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3571
Mailing Address - Country:US
Mailing Address - Phone:248-313-2900
Mailing Address - Fax:
Practice Address - Street 1:326 N STATE RD
Practice Address - Street 2:
Practice Address - City:OTISVILLE
Practice Address - State:MI
Practice Address - Zip Code:48463-9501
Practice Address - Country:US
Practice Address - Phone:810-969-2949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker