Healthcare Provider Details

I. General information

NPI: 1467397729
Provider Name (Legal Business Name): CHRISTINA DIANA KRUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 N 21ST ST
SAINT HELENS OR
97051-6217
US

IV. Provider business mailing address

3 MONROE PKWY STE P454
LAKE OSWEGO OR
97035-1486
US

V. Phone/Fax

Practice location:
  • Phone: 503-369-2460
  • Fax: 503-670-7507
Mailing address:
  • Phone: 303-859-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberIHC-ED88B352
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: