Healthcare Provider Details

I. General information

NPI: 1497843049
Provider Name (Legal Business Name): MARGARET IRENE KRUCKEMEYER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 WEST THIRD STREET (117) VA MEDICAL CENTER
DAYTON OH
45428
US

IV. Provider business mailing address

2935 TARA TRL
BEAVERCREEK OH
45434-6252
US

V. Phone/Fax

Practice location:
  • Phone: 937-268-6511
  • Fax: 937-267-7599
Mailing address:
  • Phone: 937-426-2925
  • Fax: 937-426-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN159490 NP-09045
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: