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General NPI Number Information
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NPI Number | 1861106791
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Entity Type | Individual
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Provider Name | CONSTANCE ROSE KRUPA
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Gender | Female
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 2701 17TH ST
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City | ROCK ISLAND
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State | IL
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Zip | 61201-5351
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Country | US
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Telephone | 309-779-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 6456 W 65TH ST
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City | CHICAGO
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State | IL
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Zip | 60638-5102
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Country | US
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Telephone | 773-554-6094
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Fax |
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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