Provider Demographics
NPI:1497220800
Name:KRUSE, PAMELA (MS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:KRUSE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4417 AHOPUEO DR
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-9401
Mailing Address - Country:US
Mailing Address - Phone:808-635-7497
Mailing Address - Fax:
Practice Address - Street 1:4417 AHOPUEO DR
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-9401
Practice Address - Country:US
Practice Address - Phone:808-635-7497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2298224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist