Provider Demographics
NPI:1891308094
Name:KRUSE, BRANDON PAUL (FNP-C; PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:PAUL
Last Name:KRUSE
Suffix:
Gender:M
Credentials:FNP-C; PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N CURTIS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1346
Mailing Address - Country:US
Mailing Address - Phone:208-283-7314
Mailing Address - Fax:208-550-3204
Practice Address - Street 1:1000 N CURTIS RD STE 202
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1346
Practice Address - Country:US
Practice Address - Phone:208-283-7314
Practice Address - Fax:208-550-3204
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID65554363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care