Provider Demographics
NPI:1891517009
Name:CHARNITSKY, KYLIE
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:CHARNITSKY
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 1:3745 GREEN BRIER BLVD APT 211A
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2620
Mailing Address - Country:US
Mailing Address - Phone:609-949-3643
Mailing Address - Fax:
Practice Address - Street 1:3745 GREEN BRIER BLVD APT 211A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2620
Practice Address - Country:US
Practice Address - Phone:609-949-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program