1497843049 NPI number — MS. MARGARET IRENE KRUCKEMEYER CNP

Table of content: MS. MARGARET IRENE KRUCKEMEYER CNP (NPI 1497843049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497843049 NPI number — MS. MARGARET IRENE KRUCKEMEYER CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRUCKEMEYER
Provider First Name:
MARGARET
Provider Middle Name:
IRENE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNP
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:
1497843049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2935 TARA TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVERCREEK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45434-6252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-426-2925
Provider Business Mailing Address Fax Number:
937-426-5123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 WEST THIRD STREET (117)
Provider Second Line Business Practice Location Address:
VA MEDICAL CENTER
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-268-6511
Provider Business Practice Location Address Fax Number:
937-267-7599
Provider Enumeration Date:
10/10/2006

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:  RN159490 NP-09045 , 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: NP-09045 . This is a "RN#159490 RN-1 COA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com