Provider Demographics
NPI:1497976880
Name:KRUEGER, JEANNE (RN)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4457 WINDING RIVER CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-6515
Mailing Address - Country:US
Mailing Address - Phone:209-476-9152
Mailing Address - Fax:
Practice Address - Street 1:8978 BAINBRIDGE PL
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4807
Practice Address - Country:US
Practice Address - Phone:209-470-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA690797163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ227464ZMedicare ID - Type Unspecified