Provider Demographics
NPI:1851684237
Name:KRUEGER, SHARRON (RNP)
Entity Type:Individual
Prefix:
First Name:SHARRON
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14642 NEWPORT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14642 NEWPORT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6057
Practice Address - Country:US
Practice Address - Phone:714-669-4466
Practice Address - Fax:714-669-4088
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15605363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily