Provider Demographics
NPI:1659932424
Name:KRUSE-ANDERSON, SANDRA JO (BSN, CLC, IBCLC)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JO
Last Name:KRUSE-ANDERSON
Suffix:
Gender:F
Credentials:BSN, CLC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:NE
Mailing Address - Zip Code:68071-0745
Mailing Address - Country:US
Mailing Address - Phone:402-878-2258
Mailing Address - Fax:402-878-2766
Practice Address - Street 1:225 S. BLUFF ST.
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:NE
Practice Address - Zip Code:68071
Practice Address - Country:US
Practice Address - Phone:402-878-2258
Practice Address - Fax:402-878-2766
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072442163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant