Healthcare Provider Details

I. General information

NPI: 1316328172
Provider Name (Legal Business Name): AMY KRAUSHAAR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NORTH AVE
NORTHFIELD MN
55057-1498
US

IV. Provider business mailing address

2000 NORTH AVE
NORTHFIELD MN
55057-1498
US

V. Phone/Fax

Practice location:
  • Phone: 507-646-1494
  • Fax:
Mailing address:
  • Phone: 507-646-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number63356
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-10396
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: