Healthcare Provider Details

I. General information

NPI: 1871227520
Provider Name (Legal Business Name): NATALIE KAY KRUSE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2022
Last Update Date: 07/10/2022
Certification Date: 07/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 GOLF COURSE RD
GRAND RAPIDS MN
55744-8648
US

IV. Provider business mailing address

21583 KEYVIEW DRIVE
GRAND RAPIDS MN
55744
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-3401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2203892
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: