Provider Demographics
NPI:1770228215
Name:KRUSE, KRISTINA HERRIOTT (AGACNP-CNS)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:HERRIOTT
Last Name:KRUSE
Suffix:
Gender:F
Credentials:AGACNP-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47-422 HUI AUKUU PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-4652
Mailing Address - Country:US
Mailing Address - Phone:217-778-5332
Mailing Address - Fax:
Practice Address - Street 1:680 IWILEI RD STE 660
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5392
Practice Address - Country:US
Practice Address - Phone:808-924-9255
Practice Address - Fax:808-922-9161
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN110698163WH1000X
HIAPRN3948364SA2100X, 363LA2100X
MDCS00154364SG0600X, 364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No163WH1000XNursing Service ProvidersRegistered NurseHospice
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology