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NPI Code Detail

MEDICARE: TYLANE KRUSE

MEDICARE: TYLANE KRUSE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-20-42061

General Provider Information

NPI Number : 1760725642
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYLANE KRUSE
Provider Business Mailing Address
First Line : 4929 DARCY WOODS LN
Second Line :
City : FUQUAY VARINA
State : NC
Zip : 27526-7622
Country : US
Telephone Number : 858-264-5858
Fax Number : 858-649-6012
Provider Business Practice Location Address
First Line : 4929 DARCY WOODS LN
Second Line :
City : FUQUAY VARINA
State : NC
Zip : 27526-7622
Country : US
Telephone Number : 919-810-1459
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2013
Last Update Date : 12/05/2023

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Directions to “ TYLANE KRUSE ” Practice Location

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