Provider Demographics
NPI:1629214796
Name:KROLL, ELIZABETH M (APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:KROLL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:REINHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23020 M ROAD
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436
Mailing Address - Country:US
Mailing Address - Phone:785-362-8677
Mailing Address - Fax:785-362-4372
Practice Address - Street 1:23020 M ROAD
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436
Practice Address - Country:US
Practice Address - Phone:785-362-8677
Practice Address - Fax:785-362-4372
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111000363LF0000X
KS78153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201196610AMedicaid