Provider Demographics
NPI:1164875852
Name:KRAUSE, BRYN MAXINE BYERS (NP)
Entity Type:Individual
Prefix:
First Name:BRYN
Middle Name:MAXINE BYERS
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 N MULFORD RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3879
Mailing Address - Country:US
Mailing Address - Phone:815-484-9900
Mailing Address - Fax:815-487-4949
Practice Address - Street 1:1235 N MULFORD RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3879
Practice Address - Country:US
Practice Address - Phone:815-484-9900
Practice Address - Fax:815-487-4949
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014452363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400314118Medicare PIN