Provider Demographics
NPI:1619126075
Name:KRAUSE, NICHOLAS DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:DAVID
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 PACIFIC AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4301
Mailing Address - Country:US
Mailing Address - Phone:253-583-8651
Mailing Address - Fax:253-581-5698
Practice Address - Street 1:1201 PACIFIC AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4301
Practice Address - Country:US
Practice Address - Phone:253-583-8651
Practice Address - Fax:253-581-5698
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 602344412085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2017482Medicaid