Provider Demographics
NPI:1073395349
Name:KRUSEMARK, COURTNEY (RN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:KRUSEMARK
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 1:2802 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3747
Mailing Address - Country:US
Mailing Address - Phone:303-815-8096
Mailing Address - Fax:
Practice Address - Street 1:2802 SW 11TH ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3747
Practice Address - Country:US
Practice Address - Phone:303-815-8096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005018854163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice