Provider Demographics
NPI:1790100162
Name:KREUDER, KRISTIN
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:KREUDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 N BUFFALO ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1853
Mailing Address - Country:US
Mailing Address - Phone:716-662-2300
Mailing Address - Fax:716-972-0006
Practice Address - Street 1:3725 N BUFFALO ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1853
Practice Address - Country:US
Practice Address - Phone:716-662-2300
Practice Address - Fax:716-972-0006
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304192164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse