Healthcare Provider Details

I. General information

NPI: 1356994099
Provider Name (Legal Business Name): WENDY S KRAUSE AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13266 SPENCE RD
THREE RIVERS MI
49093-9707
US

IV. Provider business mailing address

13266 SPENCE RD
THREE RIVERS MI
49093-9707
US

V. Phone/Fax

Practice location:
  • Phone: 269-535-4085
  • Fax:
Mailing address:
  • Phone: 269-535-4085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704213959
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704213959
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: