Healthcare Provider Details

I. General information

NPI: 1316003510
Provider Name (Legal Business Name): UROGYN CONSULTATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 COUNTY ROAD Z
BLUE MOUNDS WI
53517-9629
US

IV. Provider business mailing address

2020 COUNTY ROAD Z
BLUE MOUNDS WI
53517-9629
US

V. Phone/Fax

Practice location:
  • Phone: 608-437-6035
  • Fax: 608-437-6035
Mailing address:
  • Phone: 608-437-6035
  • Fax: 608-437-6035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELLY L KRUSE
Title or Position: NURSE PRACTITIONER - OWNER
Credential: NP
Phone: 608-437-6035