Provider Demographics
NPI:1750316253
Name:PLOTE-KRAUSE, PAULA M (APN)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:M
Last Name:PLOTE-KRAUSE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MISS
Other - First Name:PAULA
Other - Middle Name:M
Other - Last Name:PLOTE-KRAUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 ROXBURY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5075
Mailing Address - Country:US
Mailing Address - Phone:815-397-7340
Mailing Address - Fax:815-397-7388
Practice Address - Street 1:401 ROXBURY RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5075
Practice Address - Country:US
Practice Address - Phone:815-397-7340
Practice Address - Fax:815-397-7388
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4578-33363L00000X
IL209001815363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ51344Medicare UPIN