Provider Demographics
NPI:1992998066
Name:KRYWKO, JILLIAN LAPRAIRIE (FNP)
Entity type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:LAPRAIRIE
Last Name:KRYWKO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1147
Mailing Address - Country:US
Mailing Address - Phone:810-600-1400
Mailing Address - Fax:810-600-1403
Practice Address - Street 1:3175 ROCHESTER ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48306
Practice Address - Country:US
Practice Address - Phone:248-853-2900
Practice Address - Fax:248-853-2906
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704226845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN34980004Medicare PIN
MIP34780077Medicare PIN