Healthcare Provider Details

I. General information

NPI: 1508070285
Provider Name (Legal Business Name): SHAWN BARBARA KRAUSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834
US

IV. Provider business mailing address

912 N BYFIELD ST
WESTLAND MI
48185-8501
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-4100
  • Fax:
Mailing address:
  • Phone: 734-883-4916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number219051
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: