Provider Demographics
NPI:1992823678
Name:KRUSE, TERESE NICKOL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TERESE
Middle Name:NICKOL
Last Name:KRUSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3641
Mailing Address - Country:US
Mailing Address - Phone:563-589-8970
Mailing Address - Fax:
Practice Address - Street 1:1920 ELM ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3641
Practice Address - Country:US
Practice Address - Phone:563-589-8970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist