Provider Demographics
NPI:1740545235
Name:KRUGER, VIRGINIA C (CNP)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:C
Last Name:KRUGER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9293 STATE ROUTE 43
Mailing Address - Street 2:SUITE B
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5374
Mailing Address - Country:US
Mailing Address - Phone:330-626-1113
Mailing Address - Fax:330-626-1133
Practice Address - Street 1:9293 STATE ROUTE 43
Practice Address - Street 2:SUITE B
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5374
Practice Address - Country:US
Practice Address - Phone:330-626-1113
Practice Address - Fax:330-626-1133
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13439363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103818Medicaid
OHH324730Medicare PIN