Provider Demographics
NPI:1710473632
Name:KRAUSE, KRISTA (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:FNP
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 616
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-0616
Mailing Address - Country:US
Mailing Address - Phone:315-668-5047
Mailing Address - Fax:315-668-5843
Practice Address - Street 1:3200 BURNET AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2424
Practice Address - Country:US
Practice Address - Phone:315-433-9999
Practice Address - Fax:315-396-0787
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335958363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily