Provider Demographics
NPI:1972763696
Name:KRUSE, LINDA LOU
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LOU
Last Name:KRUSE
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 1:10695 STATE ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45830-8201
Mailing Address - Country:US
Mailing Address - Phone:419-659-2722
Mailing Address - Fax:
Practice Address - Street 1:10695 STATE ROUTE 12
Practice Address - Street 2:
Practice Address - City:COLUMBUS GROVE
Practice Address - State:OH
Practice Address - Zip Code:45830-8201
Practice Address - Country:US
Practice Address - Phone:419-659-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2209612Medicaid