Provider Demographics
NPI:1720444920
Name:KROUBETZ, BRANDY (RN)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:KROUBETZ
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:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:BLACKDUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56630
Mailing Address - Country:US
Mailing Address - Phone:218-368-7461
Mailing Address - Fax:
Practice Address - Street 1:190 SAILSTAR DR NW
Practice Address - Street 2:
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633-3565
Practice Address - Country:US
Practice Address - Phone:218-368-7461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-228313-9163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse