Provider Demographics
NPI:1972678936
Name:KRUSE, LEANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:KRUSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 UNDERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:IA
Mailing Address - Zip Code:50621-9611
Mailing Address - Country:US
Mailing Address - Phone:641-366-9126
Mailing Address - Fax:641-752-7177
Practice Address - Street 1:704 MAY ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-3437
Practice Address - Country:US
Practice Address - Phone:641-752-7159
Practice Address - Fax:641-752-7177
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF080031363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI7836Medicare ID - Type Unspecified