Provider Demographics
NPI:1639684178
Name:KRUGH, MEREDITH MARIE (NP)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:MARIE
Last Name:KRUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 HOLLYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-9149
Mailing Address - Country:US
Mailing Address - Phone:269-428-4411
Mailing Address - Fax:269-428-4422
Practice Address - Street 1:1211 STATELINE RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-4729
Practice Address - Country:US
Practice Address - Phone:269-684-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015369A363L00000X
MI4704253566363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner