Provider Demographics
NPI:1902186968
Name:KRAUSE, DEBORAH O (NP-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:O
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-863-9850
Mailing Address - Fax:704-863-9851
Practice Address - Street 1:101 E WT HARRIS BLVD
Practice Address - Street 2:BUILDING 1000, SUITE 1110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-863-9850
Practice Address - Fax:704-863-9851
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005281363L00000X
NC111830363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902186968Medicaid
SCNP3072Medicaid
SCNP3072Medicaid