Healthcare Provider Details

I. General information

NPI: 1417314295
Provider Name (Legal Business Name): SARA KRUSE MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 4TH STREET NW
WATERTOWN SD
57201
US

IV. Provider business mailing address

901 4TH STREET NW
WATERTOWN SD
57201-8331
US

V. Phone/Fax

Practice location:
  • Phone: 605-886-8471
  • Fax:
Mailing address:
  • Phone: 605-886-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP001029
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: