Provider Demographics
NPI:1912304106
Name:KRYWALSKI, MAGGIE KATHLEEN (FNP)
Entity type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:KATHLEEN
Last Name:KRYWALSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:MAGGIE
Other - Middle Name:KATHLEEN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:505 IRVING AVE
Mailing Address - Street 2:SUITE 1249
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1718
Mailing Address - Country:US
Mailing Address - Phone:315-464-8986
Mailing Address - Fax:315-464-2329
Practice Address - Street 1:505 IRVING AVE
Practice Address - Street 2:SUITE 1249
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1718
Practice Address - Country:US
Practice Address - Phone:315-464-8986
Practice Address - Fax:315-464-2329
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338744-1364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health