1740461615 NPI number — MRS. PATRICIA LORAIN KRAUSE MSN, C-FNP

Table of content: MRS. PATRICIA LORAIN KRAUSE MSN, C-FNP (NPI 1740461615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740461615 NPI number — MRS. PATRICIA LORAIN KRAUSE MSN, C-FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAUSE
Provider First Name:
PATRICIA
Provider Middle Name:
LORAIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, C-FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740461615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/30/2017
NPI Reactivation Date:
09/12/2017

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 N. FIFTH STREET
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MARTINS FERRY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-232-6104
Provider Business Mailing Address Fax Number:
740-609-3483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 N. FIFTH STREET
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MARTINS FERRY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-232-6104
Provider Business Practice Location Address Fax Number:
740-609-3483
Provider Enumeration Date:
11/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  50122 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 09985 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2976285 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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