Provider Demographics
NPI:1881312098
Name:KRUCHTEN, REBECCA JOE (RN)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:JOE
Last Name:KRUCHTEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:CO
Mailing Address - Zip Code:80645-3081
Mailing Address - Country:US
Mailing Address - Phone:303-416-0226
Mailing Address - Fax:
Practice Address - Street 1:313 SUNSET DR
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:CO
Practice Address - Zip Code:80645-3081
Practice Address - Country:US
Practice Address - Phone:303-416-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO199260163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse