Provider Demographics
NPI:1346435146
Name:KRUTSINGER, ALLISON (PAC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:KRUTSINGER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1210
Mailing Address - Country:US
Mailing Address - Phone:641-774-8103
Mailing Address - Fax:641-774-8087
Practice Address - Street 1:1200 N 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARITON
Practice Address - State:IA
Practice Address - Zip Code:50049-1210
Practice Address - Country:US
Practice Address - Phone:641-774-8103
Practice Address - Fax:641-774-8087
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001846363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA72483OtherWELLMARK
IA1346435146OtherWELLMARK
IAP00446119Medicare Oscar/Certification
IAI69510028Medicare PIN
IA72483OtherWELLMARK
IAI21477Medicare PIN