Provider Demographics
NPI:1497843049
Name:KRUCKEMEYER, MARGARET IRENE (CNP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:IRENE
Last Name:KRUCKEMEYER
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:2935 TARA TRL
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6252
Mailing Address - Country:US
Mailing Address - Phone:937-426-2925
Mailing Address - Fax:937-426-5123
Practice Address - Street 1:4100 WEST THIRD STREET (117)
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:937-267-7599
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN159490 NP-09045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP-09045OtherRN#159490 RN-1 COA