Healthcare Provider Details

I. General information

NPI: 1245877364
Provider Name (Legal Business Name): CHARLENE MARIE KRAUSE RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 N LINCOLN LAKE DR
COAL CITY IL
60416-9505
US

IV. Provider business mailing address

2880 N LINCOLN LAKE DR
COAL CITY IL
60416-9505
US

V. Phone/Fax

Practice location:
  • Phone: 815-474-1221
  • Fax:
Mailing address:
  • Phone: 815-474-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number041232568
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: