Healthcare Provider Details

I. General information

NPI: 1124797303
Provider Name (Legal Business Name): BECKIE JEAN KRONEBUSCH APRN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WEST AVE S
LA CROSSE WI
54601-4783
US

IV. Provider business mailing address

700 WEST AVE S
LA CROSSE WI
54601-4783
US

V. Phone/Fax

Practice location:
  • Phone: 608-392-9413
  • Fax:
Mailing address:
  • Phone: 608-392-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0470
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: