Provider Demographics
NPI:1770819740
Name:KRUSE, ANDRIA D (CNM)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:D
Last Name:KRUSE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3680 RAMONA DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-0160
Mailing Address - Country:US
Mailing Address - Phone:951-544-9482
Mailing Address - Fax:
Practice Address - Street 1:10601 CHURCH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6863
Practice Address - Country:US
Practice Address - Phone:909-989-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1873367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife