Healthcare Provider Details

I. General information

NPI: 1407855919
Provider Name (Legal Business Name): MARLA C. KRUEGER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N MAIN ST
WHEATON IL
60187-3112
US

IV. Provider business mailing address

1800 N MAIN ST
WHEATON IL
60187-3112
US

V. Phone/Fax

Practice location:
  • Phone: 630-653-4240
  • Fax: 630-315-6557
Mailing address:
  • Phone: 630-653-4240
  • Fax: 630-315-6557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209000624
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209000624
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: