Provider Demographics
NPI:1336121367
Name:KRAUS, MELANIE CAROL (APRN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:CAROL
Last Name:KRAUS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:CAROL
Other - Last Name:HOGBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 FALLS BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-9005
Mailing Address - Country:US
Mailing Address - Phone:860-589-3816
Mailing Address - Fax:
Practice Address - Street 1:234 GLENBROOK RD
Practice Address - Street 2:UNIT4011
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-9099
Practice Address - Country:US
Practice Address - Phone:860-486-4700
Practice Address - Fax:860-486-5300
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002345363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT500000876Medicare ID - Type Unspecified
P41666Medicare UPIN