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General NPI Number Information
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NPI Number | 1790867745
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Entity Type | Individual
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Provider Name | KRISTINE C. KRUEGER CST/CSA
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 515 KINGS RD.
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City | DOUBLE OAK
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State | TX
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Zip | 75077
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Country | US
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Telephone | 817-430-3521
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Fax |
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Provider Business Mailing Address
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Address Line | 515 KINGS RD
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City | DOUBLE OAK
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State | TX
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Zip | 75077-3028
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Country | US
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Telephone | 817-430-3521
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Fax | 817-886-3953
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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 | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State | TX
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