Provider Demographics
NPI:1013187434
Name:KRAUSE, JANNINE (ND, LAC)
Entity Type:Individual
Prefix:
First Name:JANNINE
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 ELLIOTT AVE
Mailing Address - Street 2:APT 102
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1667
Mailing Address - Country:US
Mailing Address - Phone:206-406-9739
Mailing Address - Fax:
Practice Address - Street 1:2004 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2704
Practice Address - Country:US
Practice Address - Phone:206-749-0169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001645208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice