Provider Demographics
NPI:1104493568
Name:KRUEGER, KATELYN CORINE (PA-C)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:CORINE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:CORINE
Other - Last Name:LUNDBLAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20819 HIGHWAY 23 NE
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:MN
Mailing Address - Zip Code:56273-9402
Mailing Address - Country:US
Mailing Address - Phone:320-760-5675
Mailing Address - Fax:
Practice Address - Street 1:20819 HIGHWAY 23 NE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:MN
Practice Address - Zip Code:56273-9402
Practice Address - Country:US
Practice Address - Phone:320-760-5675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant