Provider Demographics
NPI:1316937113
Name:KRUSE, BRENDA J (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:J
Last Name:KRUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:JO
Other - Last Name:MCDEVITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5793
Mailing Address - Country:US
Mailing Address - Phone:515-239-2182
Mailing Address - Fax:515-239-3665
Practice Address - Street 1:1111 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-239-2182
Practice Address - Fax:515-239-3665
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33895207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0227348Medicaid
IAI1561Medicare ID - Type Unspecified
IA0227348Medicaid