Provider Demographics
NPI:1215337845
Name:KRAUSE, HEIDEMARIE
Entity type:Individual
Prefix:
First Name:HEIDEMARIE
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E CHICAGO AVE
Mailing Address - Street 2:UNIT 356
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 E CHICAGO AVE
Practice Address - Street 2:UNIT 356
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2026
Practice Address - Country:US
Practice Address - Phone:312-622-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20911986367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered