Provider Demographics
NPI:1497345219
Name:KROUSE, CAROLYN BACKES (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:BACKES
Last Name:KROUSE
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-423-5874
Mailing Address - Fax:310-423-0139
Practice Address - Street 1:8635 W 3RD ST STE 795W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6129
Practice Address - Country:US
Practice Address - Phone:310-423-5874
Practice Address - Fax:310-423-0139
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031121363LA2100X
MI4704317212363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care