Provider Demographics
NPI:1396089777
Name:KRUSE, REBECCA LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNN
Last Name:KRUSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:83 OLIVE ST
Mailing Address - Street 2:LEVEL 2
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6910
Mailing Address - Country:US
Mailing Address - Phone:815-790-3244
Mailing Address - Fax:
Practice Address - Street 1:323 CROMWELL AVE
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1801
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-652-9787
Is Sole Proprietor?:No
Enumeration Date:2012-11-25
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT5136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily