Provider Demographics
NPI:1023489366
Name:PATEL, KRISHNA (RN, NP)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:KRISHNA
Other - Middle Name:NARENDRABHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP
Mailing Address - Street 1:2673 AVIS DR SOUTH
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310
Mailing Address - Country:US
Mailing Address - Phone:586-275-4549
Mailing Address - Fax:
Practice Address - Street 1:2673 AVIS DR SOUTH
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310
Practice Address - Country:US
Practice Address - Phone:586-275-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704286969363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily