Provider Demographics
NPI:1497897961
Name:KRUGER, DAVIDA F (MSN,APRN-BC,BC-AMD)
Entity Type:Individual
Prefix:
First Name:DAVIDA
Middle Name:F
Last Name:KRUGER
Suffix:
Gender:F
Credentials:MSN,APRN-BC,BC-AMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1225
Mailing Address - Country:US
Mailing Address - Phone:313-671-6961
Mailing Address - Fax:313-916-3907
Practice Address - Street 1:3031 W GRAND BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3046
Practice Address - Country:US
Practice Address - Phone:313-916-3906
Practice Address - Fax:313-916-3907
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704116948163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMK1447817-MLPOtherDEA
MIP21416Medicare UPIN