Provider Demographics
NPI:1710014329
Name:KRUEGER, NANNETTE MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:NANNETTE
Middle Name:MARIE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12807 469TH PL SE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-8818
Mailing Address - Country:US
Mailing Address - Phone:425-831-5316
Mailing Address - Fax:
Practice Address - Street 1:1407 BOALCH AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-7994
Practice Address - Country:US
Practice Address - Phone:425-888-2777
Practice Address - Fax:425-888-2010
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002268171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor