Provider Demographics
NPI:1316061286
Name:KRAUSE, AMYANN L (ATC, EMT)
Entity type:Individual
Prefix:
First Name:AMYANN
Middle Name:L
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4231 NE 5TH ST APT A103
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4735
Mailing Address - Country:US
Mailing Address - Phone:304-629-1238
Mailing Address - Fax:
Practice Address - Street 1:21525 STATE ROUTE 410 E
Practice Address - Street 2:SUITE B
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-4101
Practice Address - Country:US
Practice Address - Phone:253-826-8520
Practice Address - Fax:253-826-8522
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer