Healthcare Provider Details

I. General information

NPI: 1134915440
Provider Name (Legal Business Name): BEVERLY KRUSE ORSAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

1138 PEG OAK
SAN ANTONIO TX
78258-3647
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax:
Mailing address:
  • Phone: 210-617-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number558950
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number558950
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: