Provider Demographics
NPI:1003869249
Name:KRUEGER, LANCE (PA-C)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S SANTA FE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4189
Mailing Address - Country:US
Mailing Address - Phone:785-452-7562
Mailing Address - Fax:785-452-7105
Practice Address - Street 1:501 S SANTA FE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4189
Practice Address - Country:US
Practice Address - Phone:785-452-7562
Practice Address - Fax:785-452-7105
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501434363AS0400X
NE493363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200715390AMedicaid
KS200715390AMedicaid