Healthcare Provider Details

I. General information

NPI: 1154441400
Provider Name (Legal Business Name): JENNY SUZANNE KRAUSE R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SAMOA BLVD
ARCATA CA
95521-6604
US

IV. Provider business mailing address

2122 ARIEL WAY
ARCATA CA
95521-9684
US

V. Phone/Fax

Practice location:
  • Phone: 707-496-5879
  • Fax: 707-825-8228
Mailing address:
  • Phone: 707-496-5879
  • Fax: 707-825-8228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number819872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: