Provider Demographics
NPI:1356994099
Name:KRAUSE, WENDY S (RN)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13266 SPENCE RD
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-9707
Mailing Address - Country:US
Mailing Address - Phone:269-535-4085
Mailing Address - Fax:
Practice Address - Street 1:13266 SPENCE RD
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-9707
Practice Address - Country:US
Practice Address - Phone:269-535-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704213959163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704213959OtherNURSING