1962786996 NPI number — JENELLE ELIZABETH KRAUS PHARMD

Table of content: JENELLE ELIZABETH KRAUS PHARMD (NPI 1962786996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962786996 NPI number — JENELLE ELIZABETH KRAUS PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAUS
Provider First Name:
JENELLE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAVRE
Provider Other First Name:
JENELLE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962786996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15034 SHANNON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEMOUNT
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55068-1795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-322-6603
Provider Business Mailing Address Fax Number:
651-322-6608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15034 SHANNON PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEMOUNT
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55068-1795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-322-6603
Provider Business Practice Location Address Fax Number:
651-322-6608
Provider Enumeration Date:
10/10/2011

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: 183500000X , with the licence number:  119819 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com