Provider Demographics
NPI:1780925545
Name:KRUSE, COURTNEY G (RD, LD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:G
Last Name:KRUSE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-3220
Mailing Address - Country:US
Mailing Address - Phone:913-894-1983
Mailing Address - Fax:913-894-0125
Practice Address - Street 1:8501 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-3220
Practice Address - Country:US
Practice Address - Phone:913-894-1983
Practice Address - Fax:913-894-0125
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1372133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered