MEDICARE: PEARL F KREKLAU-CAPONERA FNP

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
1	363L00000X	Nurse Practitioner	AP30006089	WA

General Provider Information

NPI Number	:	1902815871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PEARL F KREKLAU-CAPONERA FNP

Provider Business Mailing Address
First Line	:	600 CAISSON HILL RD
Second Line	:	US MEDDAC, IACH
City	:	FORT RILEY
State	:	KS
Zip	:	66442-7037
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 CAISSON HILL RD
Second Line	:	US MEDDAC, IACH
City	:	FORT RILEY
State	:	KS
Zip	:	66442-7037
Country	:	US
Telephone Number	:	785-240-7494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	03/24/2013

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