Provider Demographics
NPI:1790867745
Name:KRUEGER, KRISTINE C (CST/CSA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:C
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:CST/CSA
Other - Prefix:MRS
Other - First Name:KRISTINE
Other - Middle Name:C
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST/CSA
Mailing Address - Street 1:515 KINGS RD
Mailing Address - Street 2:
Mailing Address - City:DOUBLE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3028
Mailing Address - Country:US
Mailing Address - Phone:817-430-3521
Mailing Address - Fax:817-886-3953
Practice Address - Street 1:515 KINGS RD.
Practice Address - Street 2:
Practice Address - City:DOUBLE OAK
Practice Address - State:TX
Practice Address - Zip Code:75077
Practice Address - Country:US
Practice Address - Phone:817-430-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other