Provider Demographics
NPI:1043952773
Name:KRUEGER, NOELLE GERARD (RN)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:GERARD
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5206 64TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6642
Mailing Address - Country:US
Mailing Address - Phone:253-278-0393
Mailing Address - Fax:
Practice Address - Street 1:1002 15TH ST SW # 10021
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-6502
Practice Address - Country:US
Practice Address - Phone:253-278-0393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00138511163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN00138511OtherRN LICENSE