Healthcare Provider Details

I. General information

NPI: 1811483415
Provider Name (Legal Business Name): NICHOLE MARIE KRUEGER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 E BELL RD STE 3100
PHOENIX AZ
85032-2136
US

IV. Provider business mailing address

3805 E BELL RD STE 3100
PHOENIX AZ
85032-2136
US

V. Phone/Fax

Practice location:
  • Phone: 602-867-8644
  • Fax: 602-606-5128
Mailing address:
  • Phone: 602-494-3656
  • Fax: 602-867-3862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11490
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: