Provider Demographics
NPI:1376874115
Name:KRUEGER, TRACY ANN (RN)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W4412 COUNTY ROAD R
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:WI
Mailing Address - Zip Code:54452-8748
Mailing Address - Country:US
Mailing Address - Phone:715-536-5506
Mailing Address - Fax:
Practice Address - Street 1:W4412 COUNTY ROAD R
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452-8748
Practice Address - Country:US
Practice Address - Phone:715-536-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI154439-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse