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General NPI Number Information
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NPI Number | 1245677392
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Entity Type | Organization
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Legal Business Name | URO GYN CONSULTATIONS LLC
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 8301 OLD SAUK RD
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City | MIDDLETON
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State | WI
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Zip | 53562-4389
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Country | US
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Telephone | 608-662-8842
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 COUNTY ROAD Z
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City | BLUE MOUNDS
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State | WI
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Zip | 53517-9629
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Country | US
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Telephone | 608-437-6035
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Fax | 608-437-6035
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Authorized Official
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Title or Position | OWNER
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Name | KELLY KRUSE
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Credential | MS, APNP
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Telephone | 608-437-6035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 84725-30
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License Number State | WI
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