Provider Demographics
NPI:1487603338
Name:HRYWNAK, VIRGINIA (DO)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:HRYWNAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3215
Mailing Address - Country:US
Mailing Address - Phone:303-772-5578
Mailing Address - Fax:303-772-8207
Practice Address - Street 1:1309 SUNSET ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3215
Practice Address - Country:US
Practice Address - Phone:303-772-5578
Practice Address - Fax:303-772-5578
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57800073Medicaid
CO57800073Medicaid