Healthcare Provider Details

I. General information

NPI: 1265470785
Provider Name (Legal Business Name): SUE F. KREUL ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5245 NW ROCKY WAY
NEWPORT OR
97365-1323
US

IV. Provider business mailing address

5245 NW ROCKY WAY
NEWPORT OR
97365-1323
US

V. Phone/Fax

Practice location:
  • Phone: 541-574-1009
  • Fax:
Mailing address:
  • Phone: 541-574-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number075034905RN/N3
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: