Provider Demographics
NPI:1043452527
Name:KRUSCHKE, KELLY ANN (DNP, FNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:KRUSCHKE
Suffix:
Gender:F
Credentials:DNP, FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39008 SHOREVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BATTLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56515-9165
Mailing Address - Country:US
Mailing Address - Phone:218-205-1995
Mailing Address - Fax:218-864-5770
Practice Address - Street 1:39008 SHOREVIEW LN
Practice Address - Street 2:
Practice Address - City:BATTLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:56515-9165
Practice Address - Country:US
Practice Address - Phone:218-205-1995
Practice Address - Fax:218-864-5770
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP2016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCNP2016OtherNURSE PRACTITIONER LISCENSE