Provider Demographics
NPI:1780663781
Name:KRUSE, BRENDA J (PA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:KRUSE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1230 E MAIN ST
Mailing Address - Street 2:PO BOX 8674
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5066
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1400 E MADISON AVE
Practice Address - Street 2:SUITE 400A
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5473
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN9539363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
970018304OtherRR MEDICARE
MN0109920OtherMEDICA
MN151319OtherUCARE
MN66B52KROtherBCBS
MNHP31696OtherHEALTH PARTNERS
1662208OtherAMERICAS PPO
41084933956001C171OtherCHAMPUS
MN672608900Medicaid
MNNA2951025903OtherPREFERRED ONE
41084933956001C171OtherCHAMPUS
MNHP31696OtherHEALTH PARTNERS