Healthcare Provider Details

I. General information

NPI: 1336546217
Provider Name (Legal Business Name): CHRISTINE KRAUSE DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 CUBERO DR NE STE C
ALBUQUERQUE NM
87109-3868
US

IV. Provider business mailing address

8100 BARSTOW ST NE APT 6102
ALBUQUERQUE NM
87122-2861
US

V. Phone/Fax

Practice location:
  • Phone: 615-202-0166
  • Fax:
Mailing address:
  • Phone: 615-202-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1156
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: