Provider Demographics
NPI:1679969299
Name:KRUEGER, TRICIA DWYER (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:DWYER
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:TRICIA
Other - Middle Name:DWYER
Other - Last Name:SANTOPIETRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1316 DENBRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2721
Mailing Address - Country:US
Mailing Address - Phone:410-744-3455
Mailing Address - Fax:
Practice Address - Street 1:25 GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5036
Practice Address - Country:US
Practice Address - Phone:203-794-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6101363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care