Provider Demographics
NPI:1932978244
Name:CRUSER, KIMBERLY MARIE (BSN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MARIE
Last Name:CRUSER
Suffix:
Gender:F
Credentials:BSN, IBCLC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:CRUSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, IBCLC
Mailing Address - Street 1:2553 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-3926
Mailing Address - Country:US
Mailing Address - Phone:610-563-7285
Mailing Address - Fax:
Practice Address - Street 1:2553 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-3926
Practice Address - Country:US
Practice Address - Phone:610-563-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAL-134904163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant