Provider Demographics
NPI:1770923633
Name:KRAUITHOEFER, MARY LOU (BSN, RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOU
Last Name:KRAUITHOEFER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15685 BROJAN DR
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-1014
Mailing Address - Country:US
Mailing Address - Phone:262-784-3110
Mailing Address - Fax:
Practice Address - Street 1:15685 BROJAN DR
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-1014
Practice Address - Country:US
Practice Address - Phone:262-784-3110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72601-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI72601-030OtherRN