Provider Demographics
NPI:1811085376
Name:KRUEGER ANDES, DAVID A (EDD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:KRUEGER ANDES
Suffix:
Gender:M
Credentials:EDD
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 1252
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-1252
Mailing Address - Country:US
Mailing Address - Phone:336-584-1744
Mailing Address - Fax:336-538-2429
Practice Address - Street 1:2224 LACY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5341
Practice Address - Country:US
Practice Address - Phone:336-584-1744
Practice Address - Fax:336-538-2429
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH308103T00000X
NC2403103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1030751OtherCIGNA BEHAVIORAL
NC6000913Medicaid
NC0464AOtherNC BCBS
NC6000913Medicaid