Provider Demographics
NPI:1831941830
Name:KRUGER, OLIVIA (CNM)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:KRUGER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2076 PERCHERON DR
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-6776
Mailing Address - Country:US
Mailing Address - Phone:760-473-4967
Mailing Address - Fax:
Practice Address - Street 1:955 E WONDER RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:540-741-7892
Practice Address - Fax:540-741-9778
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189840367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife