Provider Demographics
NPI:1821271784
Name:KRUEGER, EMILY CONRAD (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CONRAD
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:1550 EMPIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2104
Mailing Address - Country:US
Mailing Address - Phone:585-922-2214
Mailing Address - Fax:585-922-2388
Practice Address - Street 1:1550 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2104
Practice Address - Country:US
Practice Address - Phone:585-922-2214
Practice Address - Fax:585-922-2388
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009134363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01131126/RGHMedicaid
NY01131126/RGHMedicaid
NY70005A/RGHMedicare PIN