Provider Demographics
NPI:1841045390
Name:KRAUSE, ALEXANDRA LAUREN (RDN, LDN)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LAUREN
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1307
Mailing Address - Country:US
Mailing Address - Phone:919-627-5532
Mailing Address - Fax:
Practice Address - Street 1:2223 S HIGHLAND DR STE E6223
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3672
Practice Address - Country:US
Practice Address - Phone:919-627-5532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
UT13504857-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered