Provider Demographics
NPI:1528517943
Name:KRUGH, TAYLOR
Entity type:Individual
Prefix:MISS
First Name:TAYLOR
Middle Name:
Last Name:KRUGH
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 1:7087 PIPESTONE RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49111-9723
Mailing Address - Country:US
Mailing Address - Phone:269-861-6364
Mailing Address - Fax:
Practice Address - Street 1:7087 PIPESTONE RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49111-9723
Practice Address - Country:US
Practice Address - Phone:269-861-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program