Provider Demographics
NPI:1053899906
Name:GRZADZINSKI, CHRISTINA RAE (PCR)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RAE
Last Name:GRZADZINSKI
Suffix:
Gender:F
Credentials:PCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25584 COLLINGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-3956
Mailing Address - Country:US
Mailing Address - Phone:248-242-2635
Mailing Address - Fax:
Practice Address - Street 1:25584 COLLINGWOOD ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-3956
Practice Address - Country:US
Practice Address - Phone:248-242-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X, 374U00000X, 376K00000X, 385HR2060X
MI82207473747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoula
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8220747Medicaid
MI8220747OtherDEPARTMENT OF HUMAN RESOURCES