MEDICARE: ALEXANDRA LAUREN KRAUSE RDN, LDN

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
1	133V00000X	Registered Dietitian
2	133V00000X	Registered Dietitian	13504857-4901	UT

General Provider Information

NPI Number	:	1841045390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA LAUREN KRAUSE RDN, LDN

Provider Business Mailing Address
First Line	:	2543 S PARK ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-1307
Country	:	US
Telephone Number	:	919-627-5532
Fax Number	:

Provider Business Practice Location Address
First Line	:	2223 S HIGHLAND DR STE E6223
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3672
Country	:	US
Telephone Number	:	919-627-5532
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2024
Last Update Date	:	09/16/2024

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