Provider Demographics
NPI:1275940769
Name:KRAUSE, TRISTAN (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 W. OAKWOOD PARK COURT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132
Mailing Address - Country:US
Mailing Address - Phone:414-435-0025
Mailing Address - Fax:414-435-0026
Practice Address - Street 1:4225 W. OAKWOOD PARK COURT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132
Practice Address - Country:US
Practice Address - Phone:414-435-0025
Practice Address - Fax:414-435-0026
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5913-33363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health