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General NPI Number Information
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NPI Number | 1710473632
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Entity Type | Individual
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Provider Name | KRISTA KRAUSE FNP
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Gender | Female
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 3200 BURNET AVE
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City | SYRACUSE
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State | NY
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Zip | 13206-2424
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Country | US
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Telephone | 315-433-9999
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Fax | 315-396-0787
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Provider Business Mailing Address
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Address Line | PO BOX 616
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City | BREWERTON
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State | NY
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Zip | 13029-0616
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Country | US
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Telephone | 315-668-5047
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Fax | 315-668-5843
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 335958
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License Number State | NY
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