Healthcare Provider Details

I. General information

NPI: 1043452527
Provider Name (Legal Business Name): KELLY ANN KRUSCHKE DNP, FNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39008 SHOREVIEW LN
BATTLE LAKE MN
56515-9165
US

IV. Provider business mailing address

39008 SHOREVIEW LN
BATTLE LAKE MN
56515-9165
US

V. Phone/Fax

Practice location:
  • Phone: 218-205-1995
  • Fax: 218-864-5770
Mailing address:
  • Phone: 218-205-1995
  • Fax: 218-864-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP2016
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: