Provider Demographics
NPI:1417700873
Name:KRAUSE, BAILEY K (RDN)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:K
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 ED MOR DR
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5813
Mailing Address - Country:US
Mailing Address - Phone:618-447-2932
Mailing Address - Fax:
Practice Address - Street 1:4902 ED MOR DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5813
Practice Address - Country:US
Practice Address - Phone:618-447-2932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164009111133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered