Provider Demographics
NPI:1164617791
Name:KRUPSKI, LAUREL L (PA)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:L
Last Name:KRUPSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 FALLS AVE E
Mailing Address - Street 2:STE A
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3463
Mailing Address - Country:US
Mailing Address - Phone:208-315-0581
Mailing Address - Fax:877-294-9892
Practice Address - Street 1:1139 FALLS AVE E
Practice Address - Street 2:STE A
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3463
Practice Address - Country:US
Practice Address - Phone:208-315-0581
Practice Address - Fax:877-294-9892
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-26013104100000X
IDPA919363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No104100000XBehavioral Health & Social Service ProvidersSocial Worker