Provider Demographics
NPI:1346505229
Name:KRULL, SUSAN RENEE (CNA, PCA, HHA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:KRULL
Suffix:
Gender:F
Credentials:CNA, PCA, HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 BROOKHAVEN DR
Mailing Address - Street 2:APT 1
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-7007
Mailing Address - Country:US
Mailing Address - Phone:716-804-1826
Mailing Address - Fax:
Practice Address - Street 1:2033 BROOKHAVEN DR
Practice Address - Street 2:APT 1
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-7007
Practice Address - Country:US
Practice Address - Phone:716-804-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X
NY002881113747P1801X
NY341969100503E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle
No376K00000XNursing Service Related ProvidersNurse's Aide