Provider Demographics
NPI:1568778157
Name:KRAUSE, JAKE LEVI (IDC)
Entity Type:Individual
Prefix:MR
First Name:JAKE
Middle Name:LEVI
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS BREMERTON # 698
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96661-2378
Mailing Address - Country:US
Mailing Address - Phone:808-471-2266
Mailing Address - Fax:
Practice Address - Street 1:USS BREMERTON (SSN 698)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96661-2378
Practice Address - Country:US
Practice Address - Phone:808-471-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman