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NPI Code Detail

MEDICARE: JEANNE KRUEGER RN

MEDICARE: JEANNE KRUEGER RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse690797CA

General Provider Information

NPI Number : 1497976880
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNE KRUEGER RN
Provider Business Mailing Address
First Line : 4457 WINDING RIVER CIR
Second Line :
City : STOCKTON
State : CA
Zip : 95219-6515
Country : US
Telephone Number : 209-476-9152
Fax Number :
Provider Business Practice Location Address
First Line : 8978 BAINBRIDGE PL
Second Line :
City : STOCKTON
State : CA
Zip : 95209-4807
Country : US
Telephone Number : 209-470-6848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 07/08/2007

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