Provider Demographics
NPI:1043000540
Name:KRAUSE/BEADLE, NYNA ROSE
Entity type:Individual
Prefix:
First Name:NYNA
Middle Name:ROSE
Last Name:KRAUSE/BEADLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22906 V ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98640-3516
Mailing Address - Country:US
Mailing Address - Phone:564-228-7664
Mailing Address - Fax:
Practice Address - Street 1:22906 V ST
Practice Address - Street 2:
Practice Address - City:OCEAN PARK
Practice Address - State:WA
Practice Address - Zip Code:98640-3516
Practice Address - Country:US
Practice Address - Phone:564-228-7664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician