Provider Demographics
NPI:1184230872
Name:KRUSE, ALISHA (LAC)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:KRUSE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:50 CHICKENBORO RD
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:NH
Mailing Address - Zip Code:03285-6504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 CHICKENBORO RD
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:NH
Practice Address - Zip Code:03285-6504
Practice Address - Country:US
Practice Address - Phone:617-834-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA277322171100000X
NH273171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist