Provider Demographics
NPI:1508421496
Name:KRUZNER, TERI SUE (RN)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:SUE
Last Name:KRUZNER
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 1:281 LACLAIR ST
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2988
Mailing Address - Country:US
Mailing Address - Phone:541-266-6700
Mailing Address - Fax:
Practice Address - Street 1:281 LACLAIR ST
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420-2988
Practice Address - Country:US
Practice Address - Phone:541-266-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091006874RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse