Healthcare Provider Details

I. General information

NPI: 1154155166
Provider Name (Legal Business Name): KATELYN KRAUSE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SALEM ROAD SUITE B
WILLINGBORO NJ
08046
US

IV. Provider business mailing address

117 MERION RD
CHERRY HILL NJ
08002-1336
US

V. Phone/Fax

Practice location:
  • Phone: 609-871-2060
  • Fax: 609-871-5467
Mailing address:
  • Phone: 609-220-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15116800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number26NJ15116800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: