Provider Demographics
NPI:1154441400
Name:KRAUSE, JENNY SUZANNE (RD)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:SUZANNE
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 ARIEL WAY
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-9684
Mailing Address - Country:US
Mailing Address - Phone:707-496-5879
Mailing Address - Fax:707-825-8228
Practice Address - Street 1:920 SAMOA BLVD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6604
Practice Address - Country:US
Practice Address - Phone:707-496-5879
Practice Address - Fax:707-825-8228
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA819872133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ43091Medicare UPIN
CAZZZ28169ZMedicare ID - Type Unspecified