Provider Demographics
NPI:1811911795
Name:KRAUSE, ROBERT G (APRN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 NICOLL ST STE 104
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2625
Mailing Address - Country:US
Mailing Address - Phone:203-606-2395
Mailing Address - Fax:
Practice Address - Street 1:285 NICOLL ST STE 104
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2625
Practice Address - Country:US
Practice Address - Phone:203-606-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE59571163WP0808X
CT002020364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004246064Medicaid