Provider Demographics
NPI:1316296775
Name:KROLL, NICHOLAS ALLAN (CRNA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALLAN
Last Name:KROLL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 RUNQUIST CT
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-3033
Mailing Address - Country:US
Mailing Address - Phone:440-371-7209
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - Street 2:UNIT 33100
Practice Address - City:APO
Practice Address - State:NY
Practice Address - Zip Code:09180-3100
Practice Address - Country:US
Practice Address - Phone:314-590-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60662786367500000X
OHCOA.13788-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered