Provider Demographics
NPI:1811483415
Name:KRUEGER, NICHOLE MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MARIE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 E BELL RD STE 3100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2136
Mailing Address - Country:US
Mailing Address - Phone:602-494-3656
Mailing Address - Fax:602-867-3862
Practice Address - Street 1:3805 E BELL RD STE 3100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2136
Practice Address - Country:US
Practice Address - Phone:602-867-8644
Practice Address - Fax:602-606-5128
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP11490363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily