Physician Compare National (NPI:1518299874)

HEALTHCARE PROVIDER: WAYLAN KRUSE

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1518299874
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8921287954
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110124000659
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KRUSE
	Individual professional last name
Provider First Name	WAYLAN
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1850 E WASHINGTON ST
	Group Practice or individual's line 1 address
City	COLTON
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	923244621
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M