Provider Demographics
NPI:1962849711
Name:URO GYN CONSULTATIONS LLC
Entity Type:Organization
Organization Name:URO GYN CONSULTATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, APNP
Authorized Official - Phone:608-437-6035
Mailing Address - Street 1:2020 COUNTY ROAD Z
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUNDS
Mailing Address - State:WI
Mailing Address - Zip Code:53517-9629
Mailing Address - Country:US
Mailing Address - Phone:608-437-6035
Mailing Address - Fax:608-437-6035
Practice Address - Street 1:3151 COUNTY ROAD CH
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-9108
Practice Address - Country:US
Practice Address - Phone:608-935-3321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI84725-30363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43961600Medicaid