Provider Demographics
NPI:1508931015
Name:KRUEGER, CHRISTINE (RNRD,CDE,CDN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:RNRD,CDE,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W GARDEN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2657
Mailing Address - Country:US
Mailing Address - Phone:315-567-0700
Mailing Address - Fax:315-253-8104
Practice Address - Street 1:37 W GARDEN ST STE 201
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2657
Practice Address - Country:US
Practice Address - Phone:315-567-0700
Practice Address - Fax:315-253-8104
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003891-01133V00000X
NY613229-01163W00000X
NY2002-0328163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB0772Medicare PIN