Provider Demographics
NPI:1720608615
Name:KRAUSE, TRACEY LAYNE (CPHT)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:LAYNE
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2569
Mailing Address - Country:US
Mailing Address - Phone:605-201-3015
Mailing Address - Fax:
Practice Address - Street 1:3209 S LOUISE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-0704
Practice Address - Country:US
Practice Address - Phone:605-362-1802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDT1833183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician