Provider Demographics
NPI:1710322656
Name:KRAUSE, MICHELLE G
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:G
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NY
Mailing Address - Zip Code:12754-1807
Mailing Address - Country:US
Mailing Address - Phone:845-292-4134
Mailing Address - Fax:845-292-4134
Practice Address - Street 1:17 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NY
Practice Address - Zip Code:12754-1807
Practice Address - Country:US
Practice Address - Phone:845-292-4134
Practice Address - Fax:845-292-4134
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator