Provider Demographics
NPI:1942798350
Name:KRAUSE, CRYSTAL ANNA JEAN
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANNA JEAN
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 MOUNTAIN CITY HWY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2873
Mailing Address - Country:US
Mailing Address - Phone:775-340-6854
Mailing Address - Fax:
Practice Address - Street 1:405 IDAHO ST STE 215
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-3753
Practice Address - Country:US
Practice Address - Phone:775-340-6854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06025130343747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant