Healthcare Provider Details

I. General information

NPI: 1205073863
Provider Name (Legal Business Name): SCOTT E KRAUSE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 MEDICAL PKWY SUITE 570
AUSTIN TX
78705-1019
US

IV. Provider business mailing address

PO BOX 840853
DALLAS TX
75284-1019
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-2554
  • Fax:
Mailing address:
  • Phone: 972-233-1999
  • Fax: 972-233-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP117542
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number081136
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: