Provider Demographics
NPI:1285019596
Name:KRUS, SHUANG
Entity Type:Individual
Prefix:
First Name:SHUANG
Middle Name:
Last Name:KRUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 S ELLSWORTH RD STE 135
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2168
Mailing Address - Country:US
Mailing Address - Phone:480-967-6888
Mailing Address - Fax:480-967-6887
Practice Address - Street 1:2919 S ELLSWORTH RD STE 135
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-2168
Practice Address - Country:US
Practice Address - Phone:480-967-6888
Practice Address - Fax:480-967-6887
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7844363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner